UPI (Provider ID): 10206
Change Report (if Any):

Short Name: BEECH BROK-SHAK

Long Name 1: BEECH BROOK
Long Name 2: FAMILY CENTER

Address 1: 11900 SHAKER BLVD
Address 2:

City: CLEVELAND
Zip Code: 44120
County: CUYA

Contact: JIM LOWERY
Title: OUT
Phone: 2168312255
FAX: 2169213099

Vendor: 10205

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016