UPI (Provider ID): 10071
Change Report (if Any):

Short Name: COMMUNITY MH-DO

Long Name 1: COMMUNITY MENTAL HEALTHCARE
Long Name 2:

Address 1: 201 HOSPITAL DRIVE
Address 2:

City: DOVER
Zip Code: 44622
County: TUSC

Contact: PAT FINLEY
Title: MIS
Phone: 3303436631
FAX: 3303438188

Vendor: 10071

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 02/29/2012

File Produced: 19MAY2012