UPI (Provider ID): 10061
Change Report (if Any):

Short Name: COMMUNITY MH-WC

Long Name 1: COMMUNITY MENTAL HEALTH
Long Name 2: CENTERS OF WARREN COUNTY

Address 1: 204 COOK RD
Address 2:

City: LEBANON
Zip Code: 45036
County: WARR

Contact: RUSSELL DERN
Title: EX DR
Phone: 5136951357
FAX: 5136952952

Vendor: 10061

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/12/2012

File Produced: 19MAY2012