UPI (Provider ID): 1048
Change Report (if Any):

Short Name: MH & REC CLINTO

Long Name 1: MENTAL HEALTH AND RECOVERY
Long Name 2: CENTER OF CLINTON COUNTY

Address 1: 953 S SOUTH STREET
Address 2:

City: WILMINGTON
Zip Code: 45177
County: CLIN

Contact: PHYLLIS MITCHELL
Title: EX DR
Phone: 9373834441
FAX: 9373832348

Vendor: 1048

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012