UPI (Provider ID): 10048
Change Report (if Any):

Short Name: PEP PHOENIX

Long Name 1: POSITIVE EDUCATION PROGRAM
Long Name 2: PHOENIX PLACE DAY TREATMENT CN

Address 1: 2280 PROFESSOR
Address 2:

City: CLEVELAND
Zip Code: 44113
County: CUYA

Contact: EDWARD ANDROS
Title:
Phone: 2167818229
FAX: 2167819325

Vendor: 10043

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016