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Facility Name Enter the name used by to designate the single facility under application* 2. Facility Number 3. Licensee Name Enter the name of the Licensee. Licensee means the individual firm partnership corporation association or county having the authority and responsibility for the operation of a licensed facility. 4. Date/Update Enter the date information is being initially recorded or updated* 5. Room Identifier Applicable to Residential Care for the Elderly only. Enter information that id ...

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