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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 15E064 04/04/2013 FORM APPROVED OMB NO. 0938-0391 X2 MULTIPLE CONSTRUCTION A. BUILDING X3 DATE SURVEY COMPLETED 03/12/2013 B. WING STREET ADDRESS CITY STATE ZIP CODE NAME OF PROVIDER OR SUPPLIER 505 N GAVIN ST MUNCIE IN 47303 BROOKSIDE HAVEN X4 ID SUMMARY STATEMENT OF DEFICIENCIES ID PREFIX EACH DEFICIENCY MUST...
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