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PRINTED 07/19/2017 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION X1 PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER OMB NO. 70 a Life Safety from Fire and the 2012 edition of the National Fire Protection Association NFPA 101 Life Safety Code LSC Chapter 19 Existing Health Care Occupancies and 410 IAC 16. 0938-0391 X2 MULTIPLE CONSTRUCTION X3 DATE SURVEY COMPLETED A. BUILDING 01 02 R 155608 B. WING...
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