UPI (Provider ID): 12787
Change Report (if Any):

Short Name: COMM TEACHNG HM

Long Name 1: COMMUNITY TEACHING HOMES INC
Long Name 2:

Address 1: 6715 DORR STREET
Address 2:

City: TOLEDO
Zip Code: 43615
County: LUCA

Contact: SHARON WARNER
Title: FIS
Phone: 4198681178
FAX: 4198681989

Vendor: 12787

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012