UPI (Provider ID): 12520
Change Report (if Any):

Short Name: FAMILY PRIDE

Long Name 1: FAMILY PRIDE OF NORTHEAST
Long Name 2: OHIO INC

Address 1: 100 PARKER COURT
Address 2:

City: CHARDON
Zip Code: 44024
County: GEAU

Contact: JAMES MCAULEY
Title: DIR
Phone: 4402861553
FAX: 4402861318

Vendor: 12520

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/22/2011

File Produced: 19MAY2012