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FOR OH FUSE LL1 2004 STATE OF ILLINOIS DEPARTMENT OF PUBLIC AID FINANCIAL AND STATISTICAL REPORT FOR LONG-TERM CARE FACILITIES (FISCAL YEAR 2004) I. DPH Facility ID Number: Facility Name: 0004754
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It is a specific form for reporting the state of Alshore House-0004754 in PDF format.
The owner or authorized representative of Alshore House-0004754 is required to file the form.
To fill out the form, you need to enter the relevant information about the state of Alshore House-0004754 in the provided fields.
The purpose of the form is to report and document the state of Alshore House-0004754 for regulatory and compliance purposes.
The specific information required to be reported on the form may vary, but it generally includes details about the condition, maintenance, and any relevant incidents related to Alshore House-0004754.
The deadline to file the form for Alshore House-0004754 in the year 2023 is usually specified by the relevant regulatory authority. Please refer to the official guidelines or contact the authority for the exact deadline.
The penalty for late filing of the form for Alshore House-0004754 may vary depending on the applicable regulations and the discretion of the regulatory authority. It is advisable to consult the official guidelines or seek professional advice for accurate information.
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