UPI (Provider ID): 12512
Change Report (if Any):

Short Name: TRAVCO BH CNTR

Long Name 1: TRAVCO BEHAVIORAL HEALTH INC
Long Name 2:

Address 1: 4030 BOARDMAN CANFIELD ROAD
Address 2:

City: CANFIELD
Zip Code: 44406
County: MAHO

Contact: TINA GORLEY
Title: VP
Phone: 3302860050
FAX: 3302860055

Vendor: 12512

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/08/2011

File Produced: 19MAY2012