Healthcare Provider Details

I. General information

NPI: 1649230665
Provider Name (Legal Business Name): SOUTH LYON HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S. WHITACRE
YERINGTON NV
89447-2561
US

IV. Provider business mailing address

P.O. BOX 940
YERINGTON NV
89447-0940
US

V. Phone/Fax

Practice location:
  • Phone: 775-463-2301
  • Fax:
Mailing address:
  • Phone: 775-463-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3378RHC-4
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYLI RESENDIZ
Title or Position: MEDICAL STAFF SUPERVISOR
Credential:
Phone: 775-463-6462