UPI (Provider ID): 1055
Change Report (if Any):

Short Name: COSHOCTON BH

Long Name 1: COSHOCTON BEHAVIORAL HEALTH
Long Name 2: CHOICES

Address 1: 140 ONE HALF SOUTH SIXTH ST
Address 2:

City: COSHOCTON
Zip Code: 438121624
County: COSH

Contact: BARBARA DIETZ
Title: INDIR
Phone: 7406220033
FAX: 7406220210

Vendor: 1055

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012