| PROVIDER | NAME | ||||||||
| 022901 | NORTHWESTERN HUMAN SRVCS | ||||||||
| Unit | S/A | ||||||||
| Srvc Cat | Service Desc | RU | FS | PA | Eff Date | Lap Date | Rate | Descr | Code |
| 13740000 | NHS PLANNED FSS RESPITE | 5035 | 35 | Y | 4/1/2002 | 06/30/10 | 120.00 | DAY | 1374 |
| 14090000 | MH RESIDENTIAL-RESPITE | 5035 | 35 | Y | 7/1/2001 | 06/30/10 | 28.25 | Day | 1409 |
| 14050000 | MH RESIDENTIAL - Rate may vary by Client | 5031 | 31 | Y | 7/1/2001 | 06/30/10 | 38.45 | Day | 1405 |
| 14070000 | MH RESIDENTIAL - Rate may vary by Client | 5035 | 35 | Y | 9/1/2001 | 06/30/10 | 28.72 | DAY | 1407 |
| 14100000 | MH RESIDENTIAL - Rate may vary by Client | 5035 | 35 | Y | 7/1/2001 | 06/30/10 | 28.25 | Day | 1410 |
| 14120000 | MH RESIDENTIAL - Rate may vary by Client | 5035 | 35 | Y | 7/1/2001 | 06/30/10 | 28.25 | DAY | 1412 |
| 14130000 | MH RESIDENTIAL - Rate may vary by Client | 5035 | 35 | Y | 7/1/2001 | 06/30/10 | 28.25 | DAY | 1413 |
| 14140000 | MH RESIDENTIAL - Rate may vary by Client | 5035 | 35 | Y | 7/1/2001 | 06/30/10 | 28.25 | DAY | 1414 |
| 14150000 | MH RESIDENTIAL - Rate may vary by Client | 5035 | 35 | Y | 7/1/2001 | 06/30/10 | 28.25 | DAY | 1415 |
| 14160000 | MH RESIDENTIAL - Rate may vary by Client | 5035 | 35 | Y | 9/1/2001 | 06/30/10 | 28.72 | DAY | 1416 |