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Healthcare Facility Application NonHospitalNew Business PO Box 590009 Birmingham, AL 352590009 800.282.6242 Fax 205.868.4040 1. Print FormIntroductory InformationSaveClear Formal Entity Name: Address:
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Follow the instructions provided on the form to provide detailed information about the non-hospital business, including its nature, location, and purpose.
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Non-hospitalnew business refers to any business activity that is not related to a hospital or healthcare facility.
Any individual or entity engaged in non-hospitalnew business activities is required to file.
Non-hospitalnew business can be filled out by providing all relevant information about the business activities, such as income, expenses, and other financial data.
The purpose of filing non-hospitalnew business is to report accurate financial information and ensure compliance with regulations.
Information such as income, expenses, assets, liabilities, and other financial data must be reported.
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