Form preview

Get the free Facility number: 004130

Get Form
PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15573211/30/2017FORM
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign facility number 004130

Edit
Edit your facility number 004130 form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your facility number 004130 form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing facility number 004130 online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Use the instructions below to start using our professional PDF editor:
1
Create an account. Begin by choosing Start Free Trial and, if you are a new user, establish a profile.
2
Upload a file. Select Add New on your Dashboard and upload a file from your device or import it from the cloud, online, or internal mail. Then click Edit.
3
Edit facility number 004130. Replace text, adding objects, rearranging pages, and more. Then select the Documents tab to combine, divide, lock or unlock the file.
4
Save your file. Select it from your list of records. Then, move your cursor to the right toolbar and choose one of the exporting options. You can save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud, among other things.
With pdfFiller, it's always easy to work with documents. Try it out!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out facility number 004130

Illustration

How to fill out facility number 004130

01
To fill out facility number 004130, follow these steps:
02
Start by obtaining the official facility number form.
03
Read the instructions provided on the form carefully.
04
Fill in your personal information accurately in the designated fields.
05
Enter the specific details of the facility, such as its location and purpose.
06
Provide any additional required information as indicated on the form.
07
Double-check all the information you have provided for accuracy and completeness.
08
Sign and date the form where necessary.
09
Submit the completed facility number form to the relevant authority or department.
10
Follow up with the authority to ensure your application is processed.
11
Keep a copy of the filled-out form for your records.

Who needs facility number 004130?

01
Facility number 004130 is required by individuals or organizations who need to register a facility for various purposes. Some examples of who might need this facility number include:
02
- Business owners registering a new business location
03
- Property owners registering a rental property
04
- Event organizers obtaining a permit for a specific venue
05
- Non-profit organizations applying for funding or grants
06
- Government departments or agencies registering government-owned facilities
07
- Researchers or scientists conducting studies or experiments at a specific facility
08
Ultimately, anyone who is required to provide a unique identification number for a facility would need facility number 004130.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.8
Satisfied
20 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The premium pdfFiller subscription gives you access to over 25M fillable templates that you can download, fill out, print, and sign. The library has state-specific facility number 004130 and other forms. Find the template you need and change it using powerful tools.
Install the pdfFiller Chrome Extension to modify, fill out, and eSign your facility number 004130, which you can access right from a Google search page. Fillable documents without leaving Chrome on any internet-connected device.
You can make any changes to PDF files, like facility number 004130, with the help of the pdfFiller Android app. Edit, sign, and send documents right from your phone or tablet. You can use the app to make document management easier wherever you are.
Fill out your facility number 004130 online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.