MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 4841
Change Report (if Any):

Short Name: CUYA JUSTICE TM

Long Name 1: CUYAHOGA CO DEPT OF CHILDREN
Long Name 2: AND FAMILY SERVICES

Address 1: 3955 EUCLID AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44115
County: CUYA

Contact: HUGH SHANNON
Title: DIR
Phone: 2164323390
FAX: 2166986924

Vendor: 10342

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 06/28/2012

File Produced: 14JUL2016