UPI (Provider ID): 12422
Change Report (if Any):

Short Name: EDWN SHAW REHAB

Long Name 1: EDWIN SHAW REHAB
Long Name 2:

Address 1: 405 TALLMADGE ROAD
Address 2:

City: CUYAHOGA FALLS
Zip Code: 44221
County: SUMM

Contact: SUSAN GREGG
Title: VPOP
Phone: 3307841271
FAX: 3307848851

Vendor: 12422

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/28/2011

File Produced: 14JUL2016