MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 1269
Change Report (if Any):

Short Name: DROP INN CENTER

Long Name 1: DROP INN CENTER SHELTER HOUSE
Long Name 2:

Address 1: 217 WEST TWELFTH STREET
Address 2:

City: CINCINNATI
Zip Code: 45202
County: HAMI

Contact: PATRICK CLIFFORD
Title: ADMN
Phone: 5137210643
FAX: 5134555045

Vendor: 1269

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/06/2012

File Produced: 19MAY2012