MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10055
Change Report (if Any):

Short Name: PEP DETROIT

Long Name 1: POSITIVE EDUCATION PROGRAM
Long Name 2: SPECIAL NEEDS PROGRAM

Address 1: 5209 DETROIT AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44102
County: CUYA

Contact: KEN MEYER
Title:
Phone: 2163614400
FAX: 2163617774

Vendor: 10043

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016