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CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF PUBLIC HEALTH STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION
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Locate the designated field on the form or document where you need to provide the name of the provider. This could be on a registration form, invoice, or any other document that requires this information.
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What is name of provider or?
Name of provider or refers to the individual or organization that is providing a service or product.
Who is required to file name of provider or?
Any individual or entity that is providing a service or product is required to file name of provider or.
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You can fill out name of provider or by providing the accurate and up-to-date information about the individual or organization that is providing the service or product.
What is the purpose of name of provider or?
The purpose of name of provider or is to identify the individual or organization that is providing the service or product.
What information must be reported on name of provider or?
The information that must be reported on name of provider or includes the name, contact information, and any other relevant details of the individual or organization providing the service or product.
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