UPI (Provider ID): 12176
Change Report (if Any):

Short Name: MENTOR

Long Name 1: OHIO MENTOR INC
Long Name 2:

Address 1: 9088 ROCKSIDE ROAD SUITE 800
Address 2:

City: VALLEY VIEW
Zip Code: 44125
County: CUYA

Contact: LISA CLARK
Title: DIR
Phone: 3308645895
FAX: 3308645843

Vendor: 12176

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/05/2012

File Produced: 14JUL2016