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PRINTED: 07/18/2022
FORM APPROVEDDivision of Health Service Regulation
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
IDENTIFICATION NUMBER:THE CHARLOTTE ASSISTED LIVING
(X4)
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The printed 0718 form is a tax form used for reporting specific financial information to the tax authorities, typically related to income or expenses.
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