Entity Details

Basic

Entity Type:
Free Standing NF/SNF (Free Standing NF/SNF)

Medicaid #:
0803551

CCN #:
165155

Occupancy Type:
Beds

Max Occupancy:
64

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
830061

Initial License Date:

Current License Date:
05/24/2024

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
05/24/2025

Months Since Last Survey:
11

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:
12/02/2022

Loss of NA Training Expires:
12/01/2024

Contact

Address:
2027 College Avenue

City:
Elk Horn

State:
Iowa

Zip:
51531-0358

Phone:
(712) 764-4201

Fax:
(712) 764-4206

URL:

Administrator/License #:
Brittany Martz / 112996

Administrator Email:
brittany.martz@good-sam.com

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: