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PRINTED: 06/22/2020 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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How to fill out 99 east main street

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Start by writing the house number, '99' at the beginning of the address
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After the house number, write the street name 'East Main Street'
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