MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 12526
Change Report (if Any):

Short Name: GREENE JUVNL CT

Long Name 1: GREENE COUNTY JUVENILE COURT
Long Name 2:

Address 1: 2100 GREENE WAY BLVD
Address 2:

City: XENIA
Zip Code: 45385
County: GREE

Contact: EMILY MAGOTEAUX
Title: INTER
Phone: 9375624000
FAX: 9375624010

Vendor: 12526

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/12/2011

File Produced: 19MAY2012