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Get HRDS HFS 953 B Disclosure Statement
R for a Long-Term Care Facility http://hfs.health.ok.gov This Disclosure Statement is being submitted for the following type of review: Initial License Amendment to previous filing Renewal License 1. Facility Identification Suspended License Facility ID # Facility Name (d.b.a. name): 2. Owner(s)/Lessor(s) of Building, Land and Equipment Information A. Name of Owner(s)/Lessor(s): Street City State Telephone Number: Zip Fax Number: B. If this Entity is a Government Entity check the typ.
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