UPI (Provider ID): 1407
Change Report (if Any):

Short Name: NOVA HOUSE

Long Name 1: NOVA HOUSE ASSOCIATION
Long Name 2:

Address 1: 732 BECKMAN STREET
Address 2:

City: DAYTON
Zip Code: 454102165
County: MONT

Contact: HERBERT RICKABAUGH
Title: CFO
Phone: 9372531680
FAX: 9372538990

Vendor: 1407

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/21/2012

File Produced: 19MAY2012