MEDICARE: LYON COUNTY D/B/A HEALTH SERVICES OF LYON COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251E00000X	Home Health Agency
2	251E00000X	Home Health Agency	IA
3	251K00000X	Public Health or Welfare Agency

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	167101	OTHER	IA	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	67101	OTHER	IA	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164414041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYON COUNTY D/B/A HEALTH SERVICES OF LYON COUNTY

Provider Business Mailing Address
First Line	:	315 FIRST AVENUE
Second Line	:	SUITE 208
City	:	ROCK RAPIDS
State	:	IA
Zip	:	51246
Country	:	US
Telephone Number	:	712-472-8200
Fax Number	:	712-472-4039

Provider Business Practice Location Address
First Line	:	315 1ST AVE
Second Line	:	SUITE 208
City	:	ROCK RAPIDS
State	:	IA
Zip	:	51246-1543
Country	:	US
Telephone Number	:	712-472-4081
Fax Number	:	712-472-4039

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JODY J FOLKENS
Credential	:	RN, BSN
Telephone Number	:	712-472-8200

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/15/2015

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Directions to “LYON COUNTY D/B/A HEALTH SERVICES OF LYON COUNTY ” Practice Location

Language	Start Address	Practice Location

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