MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10085
Change Report (if Any):

Short Name: PATHWAYS

Long Name 1: PATHWAYS INC
Long Name 2:

Address 1: 7350 PALISADES PARKWAY
Address 2:

City: MENTOR
Zip Code: 440605302
County: LAKE

Contact: CATHY MEKULSIA
Title: BILCO
Phone: 4409181000
FAX: 4409181029

Vendor: 10085

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/18/2011

File Produced: 19MAY2012