UPI (Provider ID): 10267
Change Report (if Any):

Short Name: BEREA-MAIN ST

Long Name 1: BEREA CHILDRENS HOME
Long Name 2:

Address 1: 364 MAIN STREET
Address 2:

City: MONROE FALLS
Zip Code: 44262
County: SUMM

Contact: JOHN CADDY
Title:
Phone: 3306882995
FAX: 3306881405

Vendor: 6871

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016