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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 15G573 05/05/2014 FORM APPROVED OMB NO. 0938-0391 X2 MULTIPLE CONSTRUCTION A. BUILDING X3 DATE SURVEY COMPLETED 04/09/2014 B. WING STREET ADDRESS CITY STATE ZIP CODE NAME OF PROVIDER OR SUPPLIER 51778 TROWBRIDGE LN SOUTH BEND IN 46637 DUNGARVIN INDIANA LLC X4 ID SUMMARY STATEMENT OF DEFICIENCIES ID PREFIX EACH...
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