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PRINTED: 05/28/2020
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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What is facility number 000017?
Facility number 000017 is a unique identifier assigned to a specific facility.
Who is required to file facility number 000017?
The owner or operator of the facility is required to file facility number 000017.
How to fill out facility number 000017?
Facility number 000017 must be filled out by providing accurate and up-to-date information about the facility.
What is the purpose of facility number 000017?
The purpose of facility number 000017 is to track and monitor the activities of the facility for regulatory and compliance purposes.
What information must be reported on facility number 000017?
Information such as the facility's location, ownership, operational details, and compliance history must be reported on facility number 000017.
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