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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES MEDICARE/MEDICAID CERTIFICATION AND TRANSMITTAL ID: ENIT Facility ID: 00168 PART I TO BE COMPLETED BY THE STATE SURVEY
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identifier for enquiring entity
Entities looking to inquire about a specific entity or data
Fill out the form with accurate and up-to-date information
To provide a unique identifier for inquiries about entities or data
Specific information related to the entity or data being inquired about
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