MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10331
Change Report (if Any):

Short Name: SAFY-HAMI

Long Name 1: SPECIALIZED ALTERNATIVES FOR
Long Name 2: FAMILIES AND YOUTH

Address 1: 260 NORTHLAND BLVD
Address 2:

City: CINCINNATI
Zip Code: 45246
County: HAMI

Contact: VERONICA CONLEY
Title:
Phone: 5137717239
FAX: 5137713878

Vendor: 10332

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/13/2012

File Produced: 19MAY2012