UPI (Provider ID): 12893
Change Report (if Any):

Short Name: LAKE HOSPITAL

Long Name 1: LAKE HOSPITAL SYSTEM INC
Long Name 2:

Address 1: 36000 EUCLID AVENUE
Address 2:

City: WILLOUGHBY
Zip Code: 44094
County: LAKE

Contact: JOSEPHINE JONES
Title: DIRB
Phone: 4409536090
FAX: 4406026578

Vendor: 12893

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/11/2012

File Produced: 19MAY2012