UPI (Provider ID): 10635
Change Report (if Any):

Short Name: PATHWAYS-ELYRIA

Long Name 1: PATHWAYS COUNSELING AND GROWTH
Long Name 2: CENTER

Address 1: 312 THIRD STREET
Address 2:

City: ELYRIA
Zip Code: 44035
County: LORA

Contact: RALPH THOMPSON
Title: EXDIR
Phone: 4403235707
FAX: 4403233016

Vendor: 10635

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012