UPI (Provider ID): 12218
Change Report (if Any):

Short Name: PATHWAY CARING

Long Name 1: PATHWAY CARING FOR CHILDREN
Long Name 2:

Address 1: 6370 WISE AVENUE NW
Address 2:

City: NORTH CANTON
Zip Code: 44720
County: STAR

Contact: ROBERT TERRY
Title: DIR
Phone: 3304930083
FAX: 3304933689

Vendor: 12218

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/27/2011

File Produced: 19MAY2012