Healthcare Provider Details

I. General information

NPI: 1285008219
Provider Name (Legal Business Name): SOUTH LYON HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S WHITACRE ST
YERINGTON NV
89447-2561
US

IV. Provider business mailing address

213 S WHITACRE ST
YERINGTON NV
89447-2561
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 TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: TONI A INSERRA
Title or Position: ADMINISTRATOR
Credential: CEO
Phone: 775-463-6404