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Get In First Steps Annual Credential Form 2021-2024

Il: ineihubenroll pcgus.com Phone: 877-522-1065 Annual credential checklist Annual credential form with signed attestation statement (page 3) Signed agreement with the Division of Disability and Rehabilitative Services (12 months current) Current limited criminal history from Indiana State Police (12 months current) National Provider Identifier (required for all providers) Copy of license (licensed providers only) Liability insurance certificate (all providers) Copy of certification (if applic.

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