UPI (Provider ID): 7165
Change Report (if Any):

Short Name: STJOHN WEST HSP

Long Name 1: ST JOHN WEST SHORE HOSPITAL
Long Name 2: SERENITY HALL

Address 1: 29000 CENTER RIDGE ROAD
Address 2:

City: WESTLAKE
Zip Code: 44145
County: CUYA

Contact: ALLEN TRACY
Title: VP
Phone: 2168616220
FAX: 4407463405

Vendor: 7166

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016