Provider Demographics
NPI:1639460892
Name:FIRELANDS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:FIRELANDS REGIONAL MEDICAL CENTER
Other - Org Name:FIRELANDS COUSELING AND RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF BEHAVIORAL HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MRUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-557-5177
Mailing Address - Street 1:1925 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4737
Mailing Address - Country:US
Mailing Address - Phone:419-557-5179
Mailing Address - Fax:
Practice Address - Street 1:675 BARTSON ROAD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420
Practice Address - Country:US
Practice Address - Phone:419-332-5524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0800389251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health