UPI (Provider ID): 989
Change Report (if Any):

Short Name: ADDICT PRG MAHO

Long Name 1: ADDICTION PROGRAM OF
Long Name 2: MAHONING COUNTY

Address 1: BODNAR TRANSITIONAL HOME
Address 2: 2516 MARKET STREET

City: YOUNGSTOWN
Zip Code: 44507
County: MAHO

Contact: BENJAMIN IANNARELLI
Title: MIS
Phone: 3307887977
FAX: 3307887447

Vendor: 989

Reports Status: NO CLAIM/N

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012