UPI (Provider ID): 10303
Change Report (if Any):

Short Name: CSN-FORENSIC TM

Long Name 1: NORTHCOAST BEHAVIORAL
Long Name 2: HEALTHCARE

Address 1: 930 SOUTH DETROIT AVENUE
Address 2:

City: TOLEDO
Zip Code: 436142701
County: LUCA

Contact: TERRY SMITH
Title: CEO
Phone: 4193811881
FAX: 4193891361

Vendor: 3275

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016