UPI (Provider ID): 11131
Change Report (if Any):

Short Name: PORTAGE PATHPES

Long Name 1: PORTAGE PATH PSYCHIATRIC
Long Name 2: EMERGENCY SERVICES

Address 1: 10 PENFIELD AVENUE
Address 2:

City: AKRON
Zip Code: 44310
County: SUMM

Contact: LAURA SHILLING
Title: ISMGR
Phone: 3307626110
FAX: 3304342818

Vendor: 10027

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/09/2011

File Produced: 14JUL2016