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04/13/2023PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/CLIAAND PLAN OF CORRECTIONIDENTIFICATION
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Facility number 011959 is a unique identifier assigned to a specific facility by the regulatory agency.
The facility owner or operator is required to file facility number 011959.
Facility number 011959 can be filled out by providing all the required information on the form provided by the regulatory agency.
The purpose of facility number 011959 is to track and monitor activities at the specific facility for regulatory compliance.
Information such as facility location, activities conducted, hazardous materials handled, and emergency contact details must be reported on facility number 011959.
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