UPI (Provider ID): 1246
Change Report (if Any):

Short Name: ORCA MARY-CUYA

Long Name 1: ORCA HOUSE
Long Name 2: MARY GOODEN RECOVERY CENTER

Address 1: 1909 EAST 89TH STREET
Address 2:

City: CLEVELAND
Zip Code: 44106
County: CUYA

Contact: GREGORY UHLAND
Title: EX DR
Phone: 2162313772
FAX: 2162315040

Vendor: 1077

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/14/2011

File Produced: 14JUL2016