University of Phoenix Material Facility Study Form Use this form to record your observations of the instructor approved facility. You will be required to submit the completed form with the final Learning Team Assignment in Week Five. Long-Term Care Facility Checklist

Part I Basic Information

Name of Long-Term Care Facility Horizon Health and Rehab Center Federal provider number 445383 Address 811 Keylon Street, Manchester, TN 37355 Phone 931-461-3425 Cultural or Religious Affiliation, if any N/A

Yes No Is the facility Medicaid Certified? _x

Is the facility Medicare Certified? _x__

Is private insurance accepted?

_x__ Are other forms of payment accepted? If so, what is acceptable?

No

Part II Licensure and Accreditation

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