MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10185
Change Report (if Any):

Short Name: DEL-MOR

Long Name 1: DEL MOR DWELLINGS CORP
Long Name 2:

Address 1: 42 ONE HALF WINTER STREET
Address 2: PO BOX 1495

City: DELAWARE
Zip Code: 43015
County: DELA

Contact: JAMES WILSON
Title: EX DR
Phone: 7403635562
FAX: 7403636736

Vendor: 10185

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012