MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 11022
Change Report (if Any):

Short Name: HOMES FOR KIDS

Long Name 1: HOMES FOR KIDS OF OHIO INC
Long Name 2:

Address 1: 43 NORTH MAIN STREET
Address 2:

City: NILES
Zip Code: 44446
County: TRUM

Contact: LISA RUMAN
Title:
Phone: 3305448005
FAX: 3305449379

Vendor: 11022

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/08/2011

File Produced: 19MAY2012