MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10076
Change Report (if Any):

Short Name: HOMESAFE ASHTB

Long Name 1: HOMESAFE INC
Long Name 2:

Address 1: PO BOX 702
Address 2:

City: ASHTABULA
Zip Code: 440050702
County: ASHT

Contact: MICHELLE LAVECK
Title: FNMGR
Phone: 4409922727
FAX: 4409981342

Vendor: 10076

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012