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Acct # Provider # CA Patient s Name: Date: (Please Print) First Middle Last Address: Apt# City State Zip Home Phone # Work# Cell# Email Address: What You Prefer to be Called: Marital Status: Single
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Account Provider CA refers to the Accounting Provider Contact Address, which is the address used to send communications related to accounting information.
Businesses or individuals who serve as accounting providers for certain entities are required to file the Account Provider CA form.
The Account Provider CA form can be filled out online or by mail by providing the necessary information related to the accounting provider contact address.
The purpose of the Account Provider CA form is to ensure that accurate and up-to-date accounting provider contact information is on file for relevant entities.
The Account Provider CA form typically requires information such as the accounting provider's name, contact information, and any relevant identification numbers.
The deadline to file the Account Provider CA form in 2024 is typically by the end of the first quarter of the year, around March or April.
The penalty for late filing of the Account Provider CA form may vary, but it can include fines or other consequences for non-compliance.
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