UPI (Provider ID): 10572
Change Report (if Any):

Short Name: LIGHTHOUSE-ASHT

Long Name 1: LIGHTHOUSE BEHAVIORAL HEALTH
Long Name 2: INC

Address 1: 355 WEST PROSPECT SUITE 124
Address 2:

City: ASHTABULA
Zip Code: 44004
County: ASHT

Contact: KEN ZACZKOWSKI
Title: EXDIR
Phone: 4409987333
FAX: 4409929242

Vendor: 10572

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012