UPI (Provider ID): 10437
Change Report (if Any):

Short Name: BEREA-DETROIT

Long Name 1: BEREA CHILDRENS HOME
Long Name 2:

Address 1: 14701 DETROIT AVENUE SUITE 211
Address 2:

City: LAKEWOOD
Zip Code: 44107
County: CUYA

Contact: JOHN CADDY
Title:
Phone: 4402342006
FAX: 4402348319

Vendor: 6871

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016