UPI (Provider ID): 12529
Change Report (if Any):

Short Name: GATHERING HOPE

Long Name 1: GATHERING HOPE HOUSE
Long Name 2:

Address 1: 1173 NORTH RIDGE ROAD E
Address 2: STE 102

City: LORAIN
Zip Code: 44055
County: LORA

Contact: JACK CAMERON
Title: CEO
Phone: 4402337400
FAX: 4402337569

Vendor: 12529

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 02/21/2012

File Produced: 19MAY2012