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ISDN Hospital Service Report
State Form 49476 (R /702)
IC 16216Status: Finalized
I. Hospital Information
Hospital
REHABILITATION HOSPITAL OF FORT WAYNE
Name:
Provider #: 153030
City: Fort Wayne, IN
County:
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03
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Provider 15-3030 is needed by individuals or organizations who offer certain types of services and need to register or apply for approval.
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It is important to check with the specific regulatory body or agency to determine whether the provider 15-3030 form is required for a particular industry or service.
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What is provider 15-3030?
Provider 15-3030 is a form used for reporting certain information related to a specific service provider.
Who is required to file provider 15-3030?
Service providers who meet specific criteria outlined in the regulations are required to file provider 15-3030.
How to fill out provider 15-3030?
Provider 15-3030 can be filled out electronically on the designated platform using the required information.
What is the purpose of provider 15-3030?
The purpose of provider 15-3030 is to collect data on service providers for regulatory and compliance purposes.
What information must be reported on provider 15-3030?
Provider 15-3030 requires details such as service provider name, contact information, services offered, number of clients served, etc.
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