UPI (Provider ID): 10042
Change Report (if Any):

Short Name: CHRISTIAN CHILD

Long Name 1: CHRISTIAN CHILDRENS HOME
Long Name 2: OF OHIO

Address 1: 2685 ARMSTRONG ROAD
Address 2:

City: WOOSTER
Zip Code: 44691
County: WAYN

Contact: SUSAN SCHLAUCH
Title:
Phone: 3303457949
FAX: 3303454218

Vendor: 10042

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/22/2011

File Produced: 19MAY2012