Provider Demographics
NPI:1164414041
Name:LYON COUNTY D/B/A HEALTH SERVICES OF LYON COUNTY
Entity Type:Organization
Organization Name:LYON COUNTY D/B/A HEALTH SERVICES OF LYON COUNTY
Other - Org Name:HEALTH SERVICES OF LYON COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOLKENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:712-472-8200
Mailing Address - Street 1:315 FIRST AVENUE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246
Mailing Address - Country:US
Mailing Address - Phone:712-472-8200
Mailing Address - Fax:712-472-4039
Practice Address - Street 1:315 1ST AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-1543
Practice Address - Country:US
Practice Address - Phone:712-472-4081
Practice Address - Fax:712-472-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251K00000X
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA167101OtherMEDICARE ID
IA67101OtherBLUE CROSS BLUE SHIELD
IA0671016Medicaid