MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10060
Change Report (if Any):

Short Name: NEW HOUSING

Long Name 1: NEW HOUSING OPPORTUNITIES
Long Name 2:

Address 1: 645 COLUMBUS AVENUE
Address 2:

City: LEBANON
Zip Code: 45036
County: WARR

Contact: TERESA CARRIER
Title: CFO
Phone: 5136951338
FAX: 5136952401

Vendor: 10060

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 02/07/2012

File Produced: 19MAY2012