UPI (Provider ID): 1285
Change Report (if Any):

Short Name: CNT CHEM ADD TX

Long Name 1: CENTER FOR CHEMICAL ADDICTIONS
Long Name 2: TREATMENT CCAT

Address 1: 830 EZZARD CHARLES DRIVE
Address 2:

City: CINCINNATI
Zip Code: 45214
County: HAMI

Contact: RONALD DERSTADT
Title: VP
Phone: 5133816672
FAX: 5133810305

Vendor: 1285

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/12/2012

File Produced: 19MAY2012