MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10996
Change Report (if Any):

Short Name: COM HOUSING NET

Long Name 1: COMMUNITY HOUSING NETWORK INC
Long Name 2:

Address 1: 957 EAST BROAD STREET
Address 2:

City: COLUMBUS
Zip Code: 43205
County: FRAN

Contact: DONALD HOLLENACK
Title: CFO
Phone: 6142511700
FAX: 6142511709

Vendor: 10996

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/29/2011

File Produced: 19MAY2012