MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10118
Change Report (if Any):

Short Name: SAFE HARBOR

Long Name 1: LORAIN COUNTY SAFE HARBOR CORP
Long Name 2:

Address 1: PO BOX 718
Address 2:

City: ELYRIA
Zip Code: 44052
County: LORA

Contact: MARILYN ZEIDNER
Title:
Phone: 4403233400
FAX: 4402441867

Vendor: 10118

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/08/2011

File Produced: 19MAY2012