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PRINTED: 11/19/2019 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:ALL CARE ASSISTED LIVING (X4)
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Printed 1119 form approved is the official tax form used by businesses to report their income, deductions, and tax liability to the government.
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