UPI (Provider ID): 1270
Change Report (if Any):

Short Name: PROSPECT HOUSE

Long Name 1: PROSPECT HOUSE
Long Name 2:

Address 1: 682 HAWTHORNE AVENUE
Address 2:

City: CINCINNATI
Zip Code: 45205
County: HAMI

Contact: JOHN EARLS
Title: CFO
Phone: 5139211613
FAX: 5139214244

Vendor: 1270

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 02/29/2012

File Produced: 19MAY2012