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Department of Assistive and Rehabilitative Services Provider Application Provider Contact Information Company Name: Physical Address (address where business is physically located): State: ZIP Code+4:
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What is provider contact information?
Provider contact information includes details such as name, address, phone number, and email address of the service provider.
Who is required to file provider contact information?
Service providers or vendors are required to file provider contact information.
How to fill out provider contact information?
Provider contact information can be filled out online through the designated platform provided by the regulatory body.
What is the purpose of provider contact information?
The purpose of provider contact information is to establish communication between the service provider and the regulatory body.
What information must be reported on provider contact information?
Provider contact information must include name, address, phone number, and email address of the service provider.
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