MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 12590
Change Report (if Any):

Short Name: SALVATION-CUYA

Long Name 1: THE SALVATION ARMY
Long Name 2:

Address 1: 1710 PROSPECT AVENUE E
Address 2:

City: CLEVELAND
Zip Code: 44115
County: CUYA

Contact: ARTHUR HILL
Title: DIR
Phone: 2167814676
FAX: 2166194720

Vendor: 10160

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/27/2012

File Produced: 14JUL2016