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PRINTED: 05/05/2021 FORM APPROVEDDivision of Health Improvement STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:BROOKDALE VALENCIA (X4) ID PREFIX

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Printed 0819 - form is a tax form used by businesses to report their income and expenses to the tax authorities.

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All businesses that operate in the specified jurisdiction and meet certain income thresholds are required to file printed 0819 - form.

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