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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15574610/02/2014FORM

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Printed 1002 refers to a specific form used for tax reporting purposes, typically associated with income, deductions, or credits within a given department of revenue.

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