UPI (Provider ID): 6662
Change Report (if Any):

Short Name: BAYSHORE

Long Name 1: BAYSHORE COUNSELING SERVICES
Long Name 2: INC

Address 1: 1218 CLEVELAND ROAD SUITE B
Address 2:

City: SANDUSKY
Zip Code: 44870
County: ERIE

Contact: TIM NAUGHTON
Title: DIR
Phone: 4196269156
FAX: 4196210099

Vendor: 6662

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/14/2011

File Produced: 19MAY2012