UPI (Provider ID): 1472
Change Report (if Any):

Short Name: LORA CNTY A/D

Long Name 1: LORAIN COUNTY ALCOHOL AND DRUG
Long Name 2: ABUSE SERVICES

Address 1: 374 BROAD STREET
Address 2:

City: ELYRIA
Zip Code: 44035
County: LORA

Contact: DARLENE RICO
Title: FISDR
Phone: 4402824777
FAX: 4402824779

Vendor: 1472

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/13/2012

File Produced: 14JUL2016