UPI (Provider ID): 10001
Change Report (if Any):

Short Name: COVA

Long Name 1: CENTER OF VOCATIONAL
Long Name 2: ALTERNATIVES

Address 1: 3770 NORTH HIGH STREET
Address 2:

City: COLUMBUS
Zip Code: 43214
County: FRAN

Contact: MIKE SARKO
Title: ISDR
Phone: 6142947117
FAX: 6142947443

Vendor: 10001

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 02/04/2012

File Produced: 19MAY2012