Healthcare Provider Details

I. General information

NPI: 1386878304
Provider Name (Legal Business Name): FIRELANDS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 PARK SQUARE DR STE B
LORAIN OH
44053-4153
US

IV. Provider business mailing address

6150 PARK SQUARE DR STE B
LORAIN OH
44053-4153
US

V. Phone/Fax

Practice location:
  • Phone: 440-984-3882
  • Fax: 440-984-3883
Mailing address:
  • Phone: 440-984-3882
  • Fax: 440-984-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL J MONCHER
Title or Position: EXECUTIVE VICE PRESIDENT & CFO
Credential:
Phone: 419-557-7793