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PRINTED: 01/29/2021 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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Facility number 000076 is a unique identifier assigned to a specific facility for regulatory or reporting purposes.
Entities operating or managing the facility associated with facility number 000076 are required to file.
To fill out facility number 000076, follow the provided forms and guidelines, ensuring all required information is accurate and complete.
The purpose of facility number 000076 is to help regulatory agencies track and monitor the operations and compliance of the specific facility.
Information such as facility name, address, type of operations, and any relevant regulatory data must be reported.
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