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04/05/2024PRINTED:
DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION
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Start by writing the street number '6855' in the designated area
02
Write 'Shore Terrace' in the street name section
03
Include 'Drive' in the address line if applicable
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Ensure to write the city, state, and ZIP code in their respective fields
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