UPI (Provider ID): 10502
Change Report (if Any):

Short Name: NB CUY ITT CSN

Long Name 1: NB CUYAHOGA INTENSIVE
Long Name 2: TREATMENT TEAM CSN

Address 1: 1708 SOUTHPOINT DRIVE
Address 2:

City: CLEVELAND
Zip Code: 44109
County: CUYA

Contact: DOUG KERN
Title: DIR
Phone: 3304677131
FAX: 3304674028

Vendor: 3275

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/05/2012

File Produced: 14JUL2016