Provider Demographics
NPI:1346200144
Name:FIRELANDS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:FIRELANDS REGIONAL MEDICAL CENTER
Other - Org Name:FIRELANDS REGIONAL MEDICAL CENTER SKILLED NURSING UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-557-7793
Mailing Address - Street 1:1912 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4736
Mailing Address - Country:US
Mailing Address - Phone:419-557-7243
Mailing Address - Fax:419-557-7101
Practice Address - Street 1:1912 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4736
Practice Address - Country:US
Practice Address - Phone:419-557-7243
Practice Address - Fax:419-557-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1165314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3293725Medicaid
OH3293725Medicaid