UPI (Provider ID): 1140
Change Report (if Any):

Short Name: RECOVERY SRVICE

Long Name 1: RECOVERY SERVICES OF NORTHWEST
Long Name 2: OHIO INC

Address 1: 511 PERRY STREET
Address 2:

City: DEFIANCE
Zip Code: 43512
County: DEFI

Contact: RUTH PECK
Title: MAN
Phone: 4197829920
FAX: 4197842523

Vendor: 1140

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012