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FOR BHF USELL1
2010
STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT (COST REPORT)
FOR LONGER CARE FACILITIES
(FISCAL YEAR 2010)I.DPH License ID Number:
Facility
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Fax 708 636-7955 is a form used for filing certain tax information with the appropriate authorities.
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