MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 12603
Change Report (if Any):

Short Name: NORTHERN RECOVY

Long Name 1: NORTHERN OHIO RECOVERY
Long Name 2: ASSOCIATION

Address 1: 3746 PROSPECT AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44115
County: CUYA

Contact: BARRY BENNETT
Title: CFO
Phone: 2163916672
FAX: 2163914633

Vendor: 12379

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016