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PRINTED: 02/19/2019 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:HOUSE OF BLESSINGS II (X4) ID
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The printed 0219 form approved is a specific tax form used for reporting certain income and tax-related information to the relevant authorities.
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