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PRINTED: 10/27/2023 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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Beforml Manor is a specific form used for filing tax-related information with the appropriate regulatory authorities. It typically pertains to reporting financial transactions or income.

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