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PRINTED: 07/22/2016 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER: CROSSWALK AT LUTHERWOODS (X4)
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Identification number - in is a unique number assigned to individuals or entities for tax purposes.
Individuals and entities that are subject to tax laws are required to file for identification number - in.
Identification number - in can be filled out online through the tax department's website or by submitting a paper form.
The purpose of identification number - in is to track and record tax obligations and payments of individuals and entities.
Information such as name, address, income, deductions, and tax credits must be reported on identification number - in.
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2016 Indiana IN00197784 IN00197437 LUTHERWOODS ROSEWALK IAC payor X2 LSC X5 X3 X6 CLIA X1 X4 QR JVKY11 Substantiated REFERENCED INDIANAPOLIS DEFICIENCIES REGULATORY PREFIX continuation CORRECTIVE PRECEDED RITTER Medicaid cited compliance DEFICIENCY

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