MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 12739
Change Report (if Any):

Short Name: WESTWOOD NORTH

Long Name 1: WESTWOOD BEHAVIORAL HEALTH
Long Name 2: CENTER INC

Address 1: 501 MCDONALD PIKE
Address 2:

City: PAULDING
Zip Code: 45879
County: PAUL

Contact: LYNN JOHNSON
Title: CFO
Phone: 4193993636
FAX: 4193995915

Vendor: 10277

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/17/2012

File Produced: 19MAY2012