UPI (Provider ID): 10053
Change Report (if Any):

Short Name: PEP GRP HOME E

Long Name 1: POSITIVE EDUCATION PROGRAM
Long Name 2: GROUP HOME EAST

Address 1: 1502 EAST 118TH STREET
Address 2:

City: CLEVELAND
Zip Code: 44106
County: CUYA

Contact: BARRY GINNIS
Title:
Phone: 2167910055
FAX: 2167910277

Vendor: 10043

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016