MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 7022
Change Report (if Any):

Short Name: COMM ASMNT-SE

Long Name 1: COMMUNITY ASSESSMENT
Long Name 2: FOUNDATION SOUTHEAST

Address 1: 7835 HARVARD AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44105
County: CUYA

Contact: BILL RICHARDSON
Title: CFO
Phone: 2164410200
FAX: 2164413176

Vendor: 6663

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016