Authorization Number : 490-0198
Agency Series No. : 10000003
Status : Active
Agency Web Link :
Agency : AGE
Confidential Description : Contains federal tax ID numbers, Social Security numbers and financial information.
Division : AGEDCL
Vital Description :
Section :
Record Title : Assisted Living Waiver
Revision : 1
Record Description : Files contain completed state and federal forms that are required for an entity to become a Medicaid Assisted Living Waiver provider. The forms contain confidential information such as social security numbers, Medicaid identification numbers, federal identification numbers, and business/company information such as financial information.