UPI (Provider ID): 10046
Change Report (if Any):

Short Name: PEP W SHORE DT

Long Name 1: POSITIVE EDUCATION PROGRAM
Long Name 2: WESTSHORE DAY TREATMENT CENTER

Address 1: 4320 WEST 220TH STREET
Address 2:

City: FAIRVIEW PARK
Zip Code: 44126
County: CUYA

Contact: TOM VALORE
Title:
Phone: 2163319391
FAX: 2163313172

Vendor: 10043

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016