CSIS PROVIDER (PROVF) SUMMARY SHEET

MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10177
Change Report (if Any):

Short Name: YWCA RES PROG

Long Name 1: YWCA RESIDENCE PROGRAM
Long Name 2:

Address 1: 244 DAYTON STREET
Address 2:

City: HAMILTON
Zip Code: 45011
County: BUTL

Contact: ANITA HOWARD
Title: EX DR
Phone: 5138569800
FAX: .

Vendor: 10177

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/28/2011

File Produced: 19MAY2012 19MAY2012