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General NPI Number Information
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NPI Number | 1508907254
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Entity Type | Organization
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Legal Business Name | CENTRAL LYON
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1105 S STORY ST
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City | ROCK RAPIDS
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State | IA
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Zip | 51246-2013
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Country | US
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Telephone | 712-472-2664
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 S STORY ST
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City | ROCK RAPIDS
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State | IA
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Zip | 51246-2013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | JACKIE WELLS
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Credential |
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Telephone | 712-472-2664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 0452516
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License Number State | IA
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