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Get FL DH 1777 2013-2024

ND OWNER INFORMATION Facility Information: Owner Information: Facility Name (as licensed, registered, or listed with state) Name of Owner Physical location (Street Address) of Facility Site Street Address City County Zip City ( Name of Contact Person State Zip ) Phone Number ( Title ) Phone Number Facility type as licensed or registered (check all that apply): Assisted Living Facility (previously ACLF) Alcohol, Drug Abuse or Mental Health Correctional Facility or Jail Day Care .

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