Provider Demographics
NPI:1134117849
Name:FIRELANDS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:FIRELANDS REGIONAL MEDICAL CENTER
Other - Org Name:FIRELANDS REGIONAL MEDICAL CENTER HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-557-7797
Mailing Address - Street 1:5420 MILAN RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5846
Mailing Address - Country:US
Mailing Address - Phone:419-557-6590
Mailing Address - Fax:419-624-0635
Practice Address - Street 1:5420 MILAN RD STE A
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5846
Practice Address - Country:US
Practice Address - Phone:419-557-6590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRELANDS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-07
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2013252Medicaid
OH367691Medicare Oscar/Certification