MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10168
Change Report (if Any):

Short Name: VOLUNTEERS NW

Long Name 1: VOLUNTEERS OF AMERICA
Long Name 2: NORTHWEST OHIO INC

Address 1: 1201 CHAMPLAIN ST
Address 2:

City: TOLEDO
Zip Code: 43604
County: LUCA

Contact: SUE REAMSNYDER
Title: EX DR
Phone: 4192483733
FAX: 4192481571

Vendor: 10168

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 02/28/2012

File Produced: 19MAY2012