Get the free 11:30 Provider: Certificate #: 001725 Phone - Wyoming
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State of WyomingCCL300 10/21Department of Family Serviceability VISIT Facility Name: LITTLE ONES DAY CARED ate: 03/03/2020Time: 11:30Provider: Certificate #: 001725Phone: 3076870684Address: 809 Aspen
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How to fill out 1130 provider certificate 001725
How to fill out 1130 provider certificate 001725
01
To fill out the 1130 provider certificate 001725 form, follow these steps:
02
Start by entering the name of the provider in the 'Provider Name' field.
03
In the 'Provider ID' field, enter the unique identification number assigned to the provider.
04
Fill in the 'Provider Type' field to indicate the type of provider (e.g., hospital, clinic, etc.).
05
Provide the address of the provider in the 'Provider Address' section, including the street, city, state, and postal code.
06
Enter the contact information of the provider, including the phone number and email address, in the respective fields.
07
If applicable, specify any additional details or information required in the provided sections.
08
Finally, review the completed form for accuracy and ensure all necessary information is provided.
09
Sign and date the form.
10
Submit the filled-out 1130 provider certificate 001725 form to the relevant authority or organization.
Who needs 1130 provider certificate 001725?
01
The 1130 provider certificate 001725 is needed by healthcare providers who want to certify their eligibility to participate in specific healthcare programs or initiatives. This form is typically required by government agencies or healthcare organizations to verify the provider's qualifications, compliance with regulations, and eligibility for reimbursement.
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What is 1130 provider certificate 001725?
The 1130 provider certificate 001725 is a specific certification form used by providers in the healthcare sector to report certain information to regulatory bodies.
Who is required to file 1130 provider certificate 001725?
Healthcare providers who participate in specific programs or receive certain types of funding are required to file the 1130 provider certificate 001725.
How to fill out 1130 provider certificate 001725?
To fill out the 1130 provider certificate 001725, providers must provide accurate information related to their services, financial data, and compliance with applicable regulations as specified in the form's instructions.
What is the purpose of 1130 provider certificate 001725?
The purpose of the 1130 provider certificate 001725 is to ensure compliance with healthcare regulations and to collect data necessary for oversight and funding purposes.
What information must be reported on 1130 provider certificate 001725?
Providers must report information such as their identification details, service descriptions, financial information, and compliance verification on the 1130 provider certificate 001725.
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