MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 1350
Change Report (if Any):

Short Name: RESCUE

Long Name 1: RESCUE MENTAL HEALTH SERVICES
Long Name 2:

Address 1: 3350 COLLINGWOOD BLVD
Address 2:

City: TOLEDO
Zip Code: 43610
County: LUCA

Contact: JIM KARASEK
Title: EX DR
Phone: 4192559585
FAX: 4192552801

Vendor: 1350

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/19/2012

File Produced: 19MAY2012