MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10210
Change Report (if Any):

Short Name: LHS

Long Name 1: LHS FAMILY AND YOUTH SERVICES
Long Name 2:

Address 1: 2411 SEMAN STREET
Address 2:

City: TOLEDO
Zip Code: 43605
County: LUCA

Contact: STEVE PLOTTNER
Title:
Phone: 4196931520
FAX: 4196933295

Vendor: 10210

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/29/2011

File Produced: 19MAY2012