UPI (Provider ID): 1183
Change Report (if Any):

Short Name: MARYHAVEN

Long Name 1: MARYHAVEN
Long Name 2:

Address 1: 1791 ALUM CREEK DRIVE
Address 2:

City: COLUMBUS
Zip Code: 43207
County: FRAN

Contact: VIVIAN RUSSELL
Title: CFO
Phone: 6144458131
FAX: 6145450239

Vendor: 1183

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/14/2011

File Produced: 19MAY2012