UPI (Provider ID): 1224
Change Report (if Any):

Short Name: RAVENWOOD MHC

Long Name 1: RAVENWOOD MENTAL HEALTH CENTER
Long Name 2:

Address 1: 695 SOUTH STREET
Address 2:

City: CHARDON
Zip Code: 44024
County: GEAU

Contact: DAVID BOYLE
Title: DIR
Phone: 4402853568
FAX: 4402854552

Vendor: 1224

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/27/2011

File Produced: 19MAY2012