UPI (Provider ID): 1168
Change Report (if Any):

Short Name: FIRELANDS-ERIE

Long Name 1: FIRELANDS COUNSELING AND
Long Name 2: RECOVERY SERVICES

Address 1: 1925 HAYES AVENUE
Address 2:

City: SANDUSKY
Zip Code: 44870
County: ERIE

Contact: MARSHA MRUK
Title:
Phone: 4195575177
FAX: 4195575179

Vendor: 1168

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/09/2011

File Produced: 19MAY2012