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01 A Life Safety Code Recertification Survey was conducted by the Indiana State Department of Health in accordance with 42 CFR 483. PRINTED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES STATEMENT OF DEFICIENCIES X1 PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER 15G331 02/17/2016 FORM APPROVED OMB NO. 0938-0391 X2 MULTIPLE CONSTRUCTION A. BUILDING X3 DATE SURVEY COMPLETED 01/14/2016 B. WING STREET ADDRESS CITY STATE ZIP CODE NAME OF...
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