UPI (Provider ID): 12679
Change Report (if Any):

Short Name: RENEWED MIND

Long Name 1: A RENEWED MIND
Long Name 2:

Address 1: 5205 EUCLID AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44103
County: CUYA

Contact: JONATHON JAMES
Title: EXDIR
Phone: 4196992486
FAX: .

Vendor: 12679

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/13/2012

File Produced: 14JUL2016