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PRINTED: 01/16/2020 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION
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112119 refers to a specific form or report that was conducted on that date, typically relating to tax or regulatory obligations.
Individuals or entities that meet certain criteria outlined by the regulatory authority or tax agency are required to file the document conducted on 112119.
To fill out the document, individuals must provide necessary personal or business information, follow the specific instructions provided, and ensure all required fields are completed accurately.
The purpose of the document is to report specific information to a regulatory or tax authority, ensuring compliance with laws and regulations.
Information that must be reported typically includes identification details, financial data, and any other information required by the relevant regulatory or tax authority.
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