UPI (Provider ID): 12766
Change Report (if Any):

Short Name: CATH CHAR-LAKE

Long Name 1: CATHOLIC CHARITIES OF
Long Name 2: LAKE COUNTY

Address 1: 8 NORTH STATE STREET ROOM 455
Address 2:

City: PAINESVILLE
Zip Code: 44077
County: LAKE

Contact: LOIS LESTOCK
Title: ACCT
Phone: 4409467264
FAX: 4403522344

Vendor: 10092

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/09/2013

File Produced: 14JUL2016