MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10294
Change Report (if Any):

Short Name: SAFEHAVEN

Long Name 1: SAFEHAVEN INC
Long Name 2:

Address 1: 633 NORTH WAYNE
Address 2:

City: PIQUA
Zip Code: 45356
County: MIAM

Contact: CYNTHIA CAMPBELL
Title: MANGR
Phone: 8005645256
FAX: 9373398837

Vendor: 10294

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012