UPI (Provider ID): 6756
Change Report (if Any):

Short Name: CONSOLDTED-LOGA

Long Name 1: CONSOLIDATED CARE INC
Long Name 2:

Address 1: 1521 NORTH DETROIT STREET
Address 2:

City: WEST LIBERTY
Zip Code: 43357
County: LOGA

Contact: KAREN OBERLIES
Title: ISDR
Phone: 9374658065
FAX: 9374651045

Vendor: 6756

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/06/2011

File Produced: 19MAY2012