UPI (Provider ID): 12259
Change Report (if Any):

Short Name: DUAL DIAGNOSIS

Long Name 1: DUAL DIAGNOSIS CENTER OF
Long Name 2: GREATER CLEVELAND

Address 1: 2012 WEST 25TH STREET STE 411
Address 2:

City: CLEVELAND
Zip Code: 44113
County: CUYA

Contact: BARBARA BERES
Title: EXDIR
Phone: 2166233555
FAX: 2166233555

Vendor: 12259

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016