MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10142
Change Report (if Any):

Short Name: ADVOCACY CENTER

Long Name 1: CENTER FOR CHILD AND FAMILY
Long Name 2: ADVOCACY INC

Address 1: 219 EAST WASHINGTON STREET
Address 2: SUITE 219

City: NAPOLEON
Zip Code: 43545
County: HENR

Contact: KRIS LAWSON
Title:
Phone: 4195920540
FAX: 4195924514

Vendor: 10142

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/27/2012

File Produced: 19MAY2012