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PRINTED: 08/18/2015 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER: LAKE PARK RESIDENTIAL CARE INC
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Identification number - in is a unique number assigned to individuals or entities for the purpose of identification.
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Information such as name, address, contact details, and other relevant personal or entity information must be reported on an identification number - in.
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