UPI (Provider ID): 4893
Change Report (if Any):

Short Name: COMM ACTION YTH

Long Name 1: COMMUNITY ACTION FOR
Long Name 2: CAPABLE YOUTH

Address 1: 1495 WEST LONGVIEW AVENUEE
Address 2: SUITE 104

City: MANSFIELD
Zip Code: 44906
County: RICH

Contact: KAREN MILLER
Title: EX EC
Phone: 4197745683
FAX: 4197746364

Vendor: 4893

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 03/28/2012

File Produced: 19MAY2012