UPI (Provider ID): 2105
Change Report (if Any):

Short Name: BEREA-E 32ND ST

Long Name 1: BEREA CHILDRENS HOME
Long Name 2:

Address 1: 2121 EAST 32ND STREET
Address 2:

City: CLEVELAND
Zip Code: 44115
County: CUYA

Contact: DAWN RIST
Title: ASTDR
Phone: 2164318117
FAX: 2164318142

Vendor: 6871

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016