UPI (Provider ID): 10183
Change Report (if Any):

Short Name: LICKING CO MH

Long Name 1: MENTAL HEALTH ASSOCIATION OF
Long Name 2: LICKING COUNTY

Address 1: 65 MESSIMER DRIVE
Address 2:

City: NEWARK
Zip Code: 43055
County: LICK

Contact: PADDY KUTZ
Title: EXDIR
Phone: 7405221341
FAX: 7405224464

Vendor: 10183

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/30/2011

File Produced: 19MAY2012