UPI (Provider ID): 12514
Change Report (if Any):

Short Name: ELLIS INSTITUTE

Long Name 1: DUKE E ELLIS HUMAN
Long Name 2: DEVELOPMENT INSTITUTE

Address 1: 9 NORTH EDWIN C MOSES BLVD
Address 2:

City: DAYTON
Zip Code: 45402
County: MONT

Contact: MARY ANN DREWRY
Title: EXDIR
Phone: 9377754300
FAX: 9377754311

Vendor: 2573

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 03/26/2012

File Produced: 14JUL2016