UPI (Provider ID): 6708
Change Report (if Any):

Short Name: NOVA BH-CANTON

Long Name 1: NOVA BEHAVIORAL HEALTH
Long Name 2:

Address 1: 832 MCKINLEY AVENUE NW
Address 2:

City: CANTON
Zip Code: 44703
County: STAR

Contact: CAROL HALES
Title:
Phone: 3304559407
FAX: 3304530007

Vendor: 6708

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012