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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15578305/20/2015FORM

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To fill out a complaint with reference number 00172134, follow these steps:

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Any individual or entity directly affected by the issue referenced in complaint in00172134 is required to file.

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Complaint in00172134 can be filled out by providing detailed description of the issue, supporting evidence, and contact information.

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Complaint in00172134 must include details of the issue, date and time of occurrence, and any relevant documentation.

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