MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 2546
Change Report (if Any):

Short Name: DARKE CNTY RECV

Long Name 1: DARKE COUNTY RECOVERY SERVICES
Long Name 2:

Address 1: 600 WALNUT STREET
Address 2:

City: GREENVILLE
Zip Code: 45331
County: DARK

Contact: MERILEE MILLER
Title: MANGR
Phone: 9375486842
FAX: 9375488938

Vendor: 2546

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/09/2011

File Produced: 19MAY2012