UPI (Provider ID): 7158
Change Report (if Any):

Short Name: FRESH START VI

Long Name 1: FRESH START
Long Name 2:

Address 1: 2415 EAST 55TH STREET
Address 2:

City: CLEVELAND
Zip Code: 44104
County: CUYA

Contact: RUBY BLACK
Title: CFO
Phone: 2164312554
FAX: 2164314878

Vendor: 6955

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 06/28/2012

File Produced: 14JUL2016