UPI (Provider ID): 10440
Change Report (if Any):

Short Name: FAMILY LIFE

Long Name 1: FAMILY LIFE COUNSELING AND
Long Name 2: PSYCHIATRIC SERVICES

Address 1: 151 MARION AVENUE
Address 2:

City: MANSFIELD
Zip Code: 44903
County: RICH

Contact: LINDA MCCLANAHAN
Title:
Phone: 4197749969
FAX: 4197565781

Vendor: 10440

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012