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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: 155717

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10. Submit the form enclosed by following the specified submission method, such as mailing it to the provided address or submitting it online through a website or portal.

Who needs by submitting form enclosed?

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What is by submitting form enclosed?

By submitting form enclosed, you are providing information to the relevant authorities.

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You can fill out the form by providing accurate and complete information as required.

What is the purpose of by submitting form enclosed?

The purpose is to report specific information to the relevant authorities.

What information must be reported on by submitting form enclosed?

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