UPI (Provider ID): 10054
Change Report (if Any):

Short Name: PEP GRP HOME W

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

Address 1: 3483 WEST BLVD
Address 2:

City: CLEVELAND
Zip Code: 44111
County: CUYA

Contact: BARRY GINNIS
Title:
Phone: 2166318929
FAX: 2166310417

Vendor: 10043

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016