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PRINTED: 04/29/2019 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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Who needs state licensure survey ending?

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Information such as contact details, professional qualifications, continuing education credits, and any disciplinary actions must be reported on state licensure survey ending.

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