UPI (Provider ID): 978
Change Report (if Any):

Short Name: CASA ALMA

Long Name 1: HISPANIC URBAN MINORITY
Long Name 2: ALCOHLISM AND DRUG ABUSE OUTRE

Address 1: 3387 FULTON ROAD
Address 2:

City: CLEVELAND
Zip Code: 44109
County: CUYA

Contact: CARLOS RAMOS
Title: EXDIR
Phone: 2163513833
FAX: 2163515933

Vendor: 2466

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/16/2011

File Produced: 14JUL2016