MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10616
Change Report (if Any):

Short Name: YOUTH OPPORTNTS

Long Name 1: YOUTH OPPORTUNITIES UNLIMITED
Long Name 2:

Address 1: 1361 EUCLID AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44115
County: CUYA

Contact: JOHN PACIOREK
Title: CFO
Phone: 2165665445
FAX: 2165665981

Vendor: 10616

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 06/28/2012

File Produced: 14JUL2016