MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10230
Change Report (if Any):

Short Name: CHILDRENS AID

Long Name 1: CHILDRENS AID SOCIETY
Long Name 2:

Address 1: 10427 DETROIT AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44102
County: CUYA

Contact: KATHLEEN GUSTAFSON
Title:
Phone: 2165216511
FAX: 2165216006

Vendor: 10230

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016