UPI (Provider ID): 10381
Change Report (if Any):

Short Name: NB MAH ITT CSN

Long Name 1: NB MAHONING INTENSIVE
Long Name 2: TREATMENT TEAM CSN

Address 1: 1344 5TH AVENUE
Address 2:

City: YOUNGSTOWN
Zip Code: 44504
County: MAHO

Contact: BARBARA YATES
Title: ASST
Phone: 3307422593
FAX: 3307422598

Vendor: 3275

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/10/2012

File Produced: 14JUL2016