UPI (Provider ID): 10097
Change Report (if Any):

Short Name: MENTAL HLTH SVC

Long Name 1: MENTAL HEALTH SERVICES
Long Name 2: DBA FRONTLINE SERVICE

Address 1: 1744 PAYNE AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44114
County: CUYA

Contact: RONALD NOWAK
Title: CFO
Phone: 2166236555
FAX: 2166236539

Vendor: 10097

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 07/01/2013

File Produced: 14JUL2016