MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 1563
Change Report (if Any):

Short Name: NEIGHBOR HOUSE

Long Name 1: NEIGHBORHOOD HOUSE
Long Name 2:

Address 1: 1000 ATCHESON STREET
Address 2:

City: COLUMBUS
Zip Code: 43203
County: FRAN

Contact: ALLEN HUFF
Title: CEO
Phone: 6142524941
FAX: 6142527919

Vendor: 1563

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/20/2011

File Produced: 19MAY2012