UPI (Provider ID): 10123
Change Report (if Any):

Short Name: BEECH ACRES

Long Name 1: BEECH ACRES PARENTING CENTER
Long Name 2:

Address 1: 6881 BEECHMONT AVENUE
Address 2:

City: CINCINNATI
Zip Code: 45230
County: HAMI

Contact: RANDALL GALE SIAS
Title: CFO
Phone: 5132316630
FAX: 5136240134

Vendor: 10123

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012