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PRINTED: 10/31/2023 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 1031 - form is a document used for reporting like-kind exchanges of real estate or personal property to the Internal Revenue Service (IRS).

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