Get the STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDERSUPPLIERCLIA IDENTIFICATION NUMBER (X2) MULTIPLE CONSTRUCTION A - idph state il

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PRINTED 05/03/2007 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION X1 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER 145316 OMB NO. 0938-0391 X2 MULTIPLE CONSTRUCTION A. BUILDING C 11/01/2006 B. WING NAME OF PROVIDER OR SUPPLIER STREET ADDRESS CITY STATE ZIP CODE 555 WEST KAHLER EMBASSY HEALTH CARE CENTER X4 ID PREFIX TAG...
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