Provider Demographics
NPI:1407815194
Name:SOUTH LYON HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SOUTH LYON HEALTH CENTER, INC.
Other - Org Name:SOUTH LYON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:INSERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-463-6404
Mailing Address - Street 1:P.O. BOX 940
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-0940
Mailing Address - Country:US
Mailing Address - Phone:775-463-2301
Mailing Address - Fax:
Practice Address - Street 1:213 S WHITACRE ST
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-2561
Practice Address - Country:US
Practice Address - Phone:775-463-2301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV660RUH-19225100000X
NV660HOS-9282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001210863Medicaid
NV290002Medicare Oscar/Certification