UPI (Provider ID): 10409
Change Report (if Any):

Short Name: NB LAKE RES CSN

Long Name 1: NB LAKE RESIDENTIAL SUPPORT
Long Name 2: CSN

Address 1: 1420 LOST NATION ROAD
Address 2:

City: WILLOUGHBY
Zip Code: 44094
County: LAKE

Contact: DOUG KERN
Title: DIR
Phone: 3304677131
FAX: 3304674028

Vendor: 3275

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/11/2012

File Produced: 14JUL2016