MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 8354
Change Report (if Any):

Short Name: FRIENDLY INN

Long Name 1: FRIENDLY INN SETTLEMENT
Long Name 2: CARVER PARK COMMUNITY COALITIO

Address 1: 2382 UNWIN ROAD
Address 2:

City: CLEVELAND
Zip Code: 44104
County: CUYA

Contact: GERALDINE BURNS
Title:
Phone: 2164317656
FAX: 2164318189

Vendor: 8354

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016