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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 15G417 02/06/2013 FORM APPROVED OMB NO. A December 2012 which indicated the nurse spoke with the lost w/c wheelchair evaluation for Nov 14th. 0938-0391 X2 MULTIPLE CONSTRUCTION A. BUILDING X3 DATE SURVEY COMPLETED 01/09/2013 B. WING STREET ADDRESS CITY STATE ZIP CODE NAME OF PROVIDER OR SUPPLIER 5625 E 56TH ST...
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