UPI (Provider ID): 3397
Change Report (if Any):

Short Name: CATH CHAR-ASHTB

Long Name 1: CATHOLIC CHARITIES OF
Long Name 2: ASHTABULA COUNTY

Address 1: 4200 PARK AVENUE FL 3
Address 2:

City: ASHTABULA
Zip Code: 44004
County: ASHT

Contact: MARK ASTORINO
Title: EXDIR
Phone: 4409922121
FAX: 4409925974

Vendor: 3397

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012