UPI (Provider ID): 1325
Change Report (if Any):

Short Name: PATHWAYS-LICKIN

Long Name 1: PATHWAYS OF CENTRAL OHIO
Long Name 2:

Address 1: 1627 BRYN MAWR DRIVE
Address 2:

City: NEWARK
Zip Code: 43055
County: LICK

Contact: MAUREEN BARNES
Title: BUSMG
Phone: 7403456166
FAX: 7403499894

Vendor: 1325

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/10/2011

File Produced: 19MAY2012