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FOR BHF USELL1 2016 STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2016)I.DPH License ID Number: Facility

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Start by writing the house number '1325' in the designated field on the form.

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Next, write 'Manchester' in the street address section.

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Finally, write 'Road' after 'Manchester' to complete the address.

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