UPI (Provider ID): 1119
Change Report (if Any):

Short Name: NEW DIREC-PEPPE

Long Name 1: NEW DIRECTIONS
Long Name 2:

Address 1: 30800 CHAGRIN BLVD
Address 2:

City: CLEVELAND
Zip Code: 44124
County: CUYA

Contact: MICHAEL MATONEY
Title: EX DR
Phone: 2165910324
FAX: 2165911243

Vendor: 1119

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/07/2011

File Produced: 14JUL2016