Get a Form or Publication: Tax ID number

Your search for "Tax ID number" returned 1 documents.

Title Type Number
Provider Credentialing Change Form

Providers use this form to notify L&I of a change of their business address, billing address and account termination. Also has info on how to notify L&I on a tax ID (EIN) number change, tax ID address change and/or name change.

Form F245-365-000



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