UPI (Provider ID): 11023
Change Report (if Any):

Short Name: TRAVCO

Long Name 1: TRAVCO REHABILITATION CENTER
Long Name 2: INC

Address 1: 4030 BOARDMAN CANFIELD ROAD
Address 2: SUITE 200C

City: CANFIELD
Zip Code: 44406
County: MAHO

Contact: TINA GORLEY
Title: VP
Phone: 3302860050
FAX: 3302860055

Vendor: 11023

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012