UPI (Provider ID): 10128
Change Report (if Any):

Short Name: LIGHTHOUSE-HAMI

Long Name 1: LIGHTHOUSE YOUTH SERVICES INC
Long Name 2:

Address 1: 401 EAST MCMILLAN ST
Address 2:

City: CINCINNATI
Zip Code: 45206
County: HAMI

Contact: TIM VALE
Title: CONTR
Phone: 5134877181
FAX: 5132213665

Vendor: 10128

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/13/2011

File Produced: 19MAY2012