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FOR BHF USELL1 2019STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2019) I.DPH License ID Number:
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Administrator type or print is a form used for administrative purposes in a business or organization.
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The individual or entity responsible for the administration of a business or organization is required to file administrator type or print.
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