Provider Demographics
NPI:1346389525
Name:FIRETREE LTD
Entity type:Organization
Organization Name:FIRETREE LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CORBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTORATE
Authorized Official - Phone:610-685-3733
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:BLDG 18-19
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-9489
Mailing Address - Country:US
Mailing Address - Phone:610-685-3733
Mailing Address - Fax:610-685-3735
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:BLDG 18-19
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-9489
Practice Address - Country:US
Practice Address - Phone:610-685-3733
Practice Address - Fax:610-685-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA067068324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019218280001Medicaid