UPI (Provider ID): 12411
Change Report (if Any):

Short Name: BETTY JANE CTR

Long Name 1: BETTY JANE MEMORIAL
Long Name 2: REHABILITATION CENTER

Address 1: 65 ST FRANCIS AVENUE
Address 2:

City: TIFFIN
Zip Code: 44883
County: SENE

Contact: PHYLLIS WHITEHEAD
Title: CFO
Phone: 4194479811
FAX: 4194472095

Vendor: 12411

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012