UPI (Provider ID): 7073
Change Report (if Any):

Short Name: FOUNDATIONS B/H

Long Name 1: FOUNDATIONS BEHAVIORAL HEALTH
Long Name 2: SERVICES

Address 1: 4761 SR 29
Address 2:

City: CELINA
Zip Code: 45822
County: MERC

Contact: LANA JOSEPH
Title:
Phone: 4195841000
FAX: 4195841825

Vendor: 7073

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012