MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10496
Change Report (if Any):

Short Name: BELLFLOWER CNTR

Long Name 1: BELLFLOWER CENTER FOR
Long Name 2: PREVENTION OF CHILD ABUSE INC

Address 1: 11811 SHAKER BOULEVARD
Address 2: SUITE 220

City: CLEVELAND
Zip Code: 44120
County: CUYA

Contact: ANN LEVIN
Title: ADMGR
Phone: 2162292420
FAX: 2162292474

Vendor: 10496

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/20/2011

File Produced: 14JUL2016