MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10537
Change Report (if Any):

Short Name: FRIENDSHIP CIRC

Long Name 1: SCHOTTENSTEIN CHABAD HOUSE
Long Name 2: FRIENDSHIP CIRCLE

Address 1: 207 EAST 15TH AVENUE
Address 2:

City: COLUMBUS
Zip Code: 43201
County: FRAN

Contact: LYNNE MCWHERTER
Title: FINC
Phone: 6142943296
FAX: 6142976495

Vendor: 10537

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/20/2011

File Produced: 19MAY2012