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PRINTED: 08/20/2020 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION

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Printed 0820 form approved is a document issued by the IRS for certain tax purposes.

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The purpose is to report certain information to the IRS for tax compliance.

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