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Get AZ Renewal License Application For A Health Care Institution 2016

INFORMATION Name of Health Care Institution: License No. Mailing Address: City: State: Phone No. Fax No. Zip Code: E-mail: Select one class or subclass (Listed in A.A.C. R9-10-102): General hospital Rural general hospital Special hospital Behavioral health inpatient facility Home health agency Unclassified health care institution Recovery care center Hospice inpatient facility Hospice service agency Outpatient surgical center Outpatie.

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