UPI (Provider ID): 12463
Change Report (if Any):

Short Name: CHILDRENS CAP

Long Name 1: CHILDRENS COMMUNITY ACCESS
Long Name 2: PROGRAM

Address 1: 5000 EUCLID AVENUE
Address 2: SUITE 204

City: CLEVELAND
Zip Code: 44105
County: CUYA

Contact: SHERRY GIBSON
Title: COO
Phone: 2163610633
FAX: 2163610644

Vendor: 12463

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 06/28/2012

File Produced: 14JUL2016