Healthcare Provider Details

I. General information

NPI: 1952820391
Provider Name (Legal Business Name): LYONS COMMUNITY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 DIAMOND ST
LYONS NE
68038-2501
US

IV. Provider business mailing address

1035 DIAMOND ST
LYONS NE
68038-2501
US

V. Phone/Fax

Practice location:
  • Phone: 402-808-1075
  • Fax:
Mailing address:
  • Phone: 402-808-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0026
License Number StateNE

VIII. Authorized Official

Name: DANIEL ARTHUR SMITH
Title or Position: VICE PRESIDENT
Credential:
Phone: 402-687-2066