MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10658
Change Report (if Any):

Short Name: PEP TREMONT AV

Long Name 1: POSTIVIE EDUCATION PROGRAM
Long Name 2:

Address 1: 2357 TREMONT AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44113
County: CUYA

Contact: KEN MEYER
Title:
Phone: 2162310400
FAX: 2163612340

Vendor: 10043

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016