UPI (Provider ID): 6689
Change Report (if Any):

Short Name: GIVING TREE

Long Name 1: THE GIVING TREE INC
Long Name 2:

Address 1: 335 BUCKEYE BLVD
Address 2:

City: PORT CLINTON
Zip Code: 43452
County: OTTA

Contact: ANN KERSTEN
Title: CO DR
Phone: 4197342942
FAX: 4197344922

Vendor: 6689

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/27/2012

File Produced: 19MAY2012