UPI (Provider ID): 10027
Change Report (if Any):

Short Name: PORTAGE PATH

Long Name 1: PORTAGE PATH BEHAVIORAL HEALTH
Long Name 2:

Address 1: 340 SOUTH BROADWAY STREET
Address 2:

City: AKRON
Zip Code: 44308
County: SUMM

Contact: JEROME KRAKER
Title:
Phone: 3303766144
FAX: .

Vendor: 10027

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/08/2011

File Produced: 14JUL2016