MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10500
Change Report (if Any):

Short Name: MULIT-DEVELOP

Long Name 1: MULTI DEVELOPMENT SERVICES
Long Name 2: OF STARK COUNTY

Address 1: 618 FULTON ROAD NW
Address 2:

City: CANTON
Zip Code: 44703
County: STAR

Contact: BETTY SMITH
Title: EXDIR
Phone: 3304548401
FAX: 3304533980

Vendor: 10500

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012