MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 2447
Change Report (if Any):

Short Name: BELLEFAIRE-FAIR

Long Name 1: BELLEFAIRE JEWISH CHILDRENS
Long Name 2: BUREAU

Address 1: 22001 FAIRMOUNT BOULEVARD
Address 2:

City: SHAKER HEIGHTS
Zip Code: 44118
County: CUYA

Contact: THOMAS BROWNE
Title: CFO
Phone: 2169322800
FAX: 2169326704

Vendor: 2447

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016