UPI (Provider ID): 1431
Change Report (if Any):

Short Name: PERRY BH

Long Name 1: PERRY BEHAVIORAL HEALTH
Long Name 2: CHOICES

Address 1: 203 NORTH MAIN STREET
Address 2:

City: NEW LEXINGTON
Zip Code: 437641264
County: PERR

Contact: JAN WADE WATTS
Title: DIR
Phone: 7403421991
FAX: 7403422914

Vendor: 1431

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012