UPI (Provider ID): 1118
Change Report (if Any):

Short Name: CROSSROADS-BELM

Long Name 1: CROSSROADS COUNSELING SERVICES
Long Name 2:

Address 1: 255 WEST MAIN STREET
Address 2:

City: ST CLAIRSVILLE
Zip Code: 43950
County: BELM

Contact: SANDRA NICHOLOFF
Title: EX DR
Phone: 7406959447
FAX: 7406958895

Vendor: 1118

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/06/2012

File Produced: 19MAY2012