UPI (Provider ID): 1135
Change Report (if Any):

Short Name: DARKE CNTY M/H

Long Name 1: DARKE COUNTY MENTAL HEALTH
Long Name 2: CLINIC

Address 1: 212 EAST MAIN STREET
Address 2:

City: GREENVILLE
Zip Code: 453310895
County: DARK

Contact: DORIS NETZLEY
Title: MANGR
Phone: 9375481635
FAX: 9375481500

Vendor: 1135

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/23/2011

File Produced: 19MAY2012