UPI (Provider ID): 10367
Change Report (if Any):

Short Name: CSN-SAGAMR-ASHL

Long Name 1: SAGAMORE HILLS WOODSIDE
Long Name 2: ASHLAND TEAM

Address 1: 635 CLAREMOUNT AVENUE
Address 2:

City: ASHLAND
Zip Code: 44805
County: ASHL

Contact: CHARLES JOHNSTON
Title: CEO
Phone: 4192817939
FAX: .

Vendor: 3275

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016