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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER: 15G507
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Start by entering the date on the designated field. The date should be written in the format MM/DD/YYYY, so for February 13, 2012, you would write 02/13/2012.
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Printed 0213 department refers to the form used for reporting certain tax information.
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Information such as income, deductions, credits, and any other tax-related details as required by the tax authorities.
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