UPI (Provider ID): 1094
Change Report (if Any):

Short Name: CLEVE TREATMENT

Long Name 1: BUREAU OF DRUG ABUSE CLEVELAND
Long Name 2: TREATMENT CENTER

Address 1: 1127 CARNEGIE AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44115
County: CUYA

Contact: CEDRIC DAVIS
Title:
Phone: 2168614246
FAX: 2168611156

Vendor: 1094

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/11/2012

File Produced: 19MAY2012