UPI (Provider ID): 12959
Change Report (if Any):

Short Name: HOUSE NEW HOPE

Long Name 1: HOUSE OF NEW HOPE
Long Name 2:

Address 1: 8135 MT VERNON ROAD
Address 2:

City: ST LOUISVILLE
Zip Code: 43071
County: LICK

Contact: JEFFREY GREENE PhD
Title: EXDIR
Phone: 7403455437
FAX: 8888106162

Vendor: 12959

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/12/2012

File Produced: 19MAY2012