MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 1536
Change Report (if Any):

Short Name: STEPS AT LIBERT

Long Name 1: STEPS AT LIBERTY CENTER
Long Name 2:

Address 1: 104 SPRINK STREET
Address 2:

City: WOOSTER
Zip Code: 44691
County: WAYN

Contact: MAC HAWKINS
Title: CFO
Phone: 3302648498
FAX: 3302643777

Vendor: 1536

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012