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PRINTED: 02/12/2020 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 000574 is a unique identifier assigned to a specific facility by the regulatory agency.
The facility owner or operator is required to file facility number 000574.
Facility number 000574 can be filled out online through the regulatory agency's website or through paper forms.
The purpose of facility number 000574 is to track and monitor activities at the specific facility for regulatory compliance.
Information such as facility location, contact information, type of activities, and certain emissions data must be reported on facility number 000574.
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