UPI (Provider ID): 4158
Change Report (if Any):

Short Name: THE CENTER-RICH

Long Name 1: THE CENTER FOR INDIVIDUAL AND
Long Name 2: FAMILY SERVICES

Address 1: 741 SCHOLL ROAD
Address 2:

City: MANSFIELD
Zip Code: 44907
County: RICH

Contact: VERONICA GROFF
Title: EX DR
Phone: 4197561717
FAX: 4197745944

Vendor: 4158

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 04/03/2012

File Produced: 19MAY2012