UPI (Provider ID): 1081
Change Report (if Any):

Short Name: SHAKER HGT-CUYA

Long Name 1: SHAKER HEIGHTS YOUTH CENTER
Long Name 2:

Address 1: 17300 VAN AKEN BLVD
Address 2:

City: SHAKER HEIGHTS
Zip Code: 441203460
County: CUYA

Contact: JOHN LISY
Title: EX DR
Phone: 2167529292
FAX: 2167527217

Vendor: 1081

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/04/2012

File Produced: 14JUL2016