1639460892 NPI number — FIRELANDS REGIONAL MEDICAL CENTER

Table of content: (NPI 1639460892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639460892 NPI number — FIRELANDS REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRELANDS REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FIRELANDS COUSELING AND RECOVERY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639460892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 HAYES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44870-4737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-557-5179
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 BARTSON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-332-5524
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MRUK
Authorized Official First Name:
MARSHA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
VICE PRESIDENT OF BEHAVIORAL HEALTH
Authorized Official Telephone Number:
419-557-5177

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  C 0800389 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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