MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10009
Change Report (if Any):

Short Name: CATH CHAR-LUCAS

Long Name 1: CATHOLIC CHARITIES
Long Name 2:

Address 1: 1933 SPIELBUSCH AVENUE
Address 2:

City: TOLEDO
Zip Code: 43697
County: LUCA

Contact: CHERI PERRIAT
Title: FIN
Phone: 4192446711
FAX: 4192444860

Vendor: 10009

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012