UPI (Provider ID): 1017
Change Report (if Any):

Short Name: LAKE RECOVERY

Long Name 1: LAKE AREA RECOVERY CENTER
Long Name 2:

Address 1: 2801 C COURT
Address 2:

City: ASHTABULA
Zip Code: 44004
County: ASHT

Contact: LISA ISHEE
Title:
Phone: 4409980722
FAX: 4409921699

Vendor: 1017

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/16/2011

File Produced: 19MAY2012