Facility Role

2158

Agency Interest ID

11565

Facility ID

Active

Facility Status

Tammy Mitchell

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Ownership Type Other

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Proposed End Date (MM/DD/YYYY)

Business/Public Agency/Other Entity

Can't Find Business

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Prefix

Owner Entity Number

First Name

OSFM ID

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Suffix

Business Name/Individual Name

Peoplesoft Customer ID

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I have met the financial responsibility requirements (in accordance with 329 IAC 9-8)

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