UPI (Provider ID): 413
Change Report (if Any):

Short Name: ADAMHS CC

Long Name 1: ALCOHOL DRUG ADDICTION MENTAL
Long Name 2: HEALTH SERVICES BD OF CUYA CO

Address 1: 1400 WEST 25TH STREET 3RD FL
Address 2:

City: CLEVELAND
Zip Code: 441133199
County: CUYA

Contact: MARK JONES
Title: DIR
Phone: 2162413400
FAX: 2168615067

Vendor: 10342

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 06/18/2013

File Produced: 14JUL2016