MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 6977
Change Report (if Any):

Short Name: REC RES-BROAD

Long Name 1: RECOVERY RESOURCES
Long Name 2:

Address 1: 374 BROAD STREET
Address 2:

City: ELYRIA
Zip Code: 44035
County: LORA

Contact: LOUIS WEIGELE
Title: PROGD
Phone: 4403225400
FAX: 4403246058

Vendor: 6973

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016