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PRINTED: 06/22/2017 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 000862 is a unique identifier for a specific facility.
The entity or individual responsible for the facility is required to file facility number 000862.
Facility number 000862 can be filled out online through the designated website or submitted through mail following the provided instructions.
The purpose of facility number 000862 is to track and monitor the activities and compliance of a specific facility with regulations.
Information such as facility location, operation type, contact details, and compliance records must be reported on facility number 000862.
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