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HEALTH CARE FACILITY LICENSING AND CERTIFICATIONā€‹

 Contact Us

Phone: (916) 552-8632

Email: CAB@cdph.ca.gov

For application status requests, please include the following in your email:

  • Application ID (if applicable)
  • Name of Facility or Agency
  • License or Facility/Agency # (if applicable)
  • Address
  • Facility or Provider Type
  • Date Documentation Sent
  • Contact Numberā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹
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End-Stage Renal Diseaseā€‹

Application Instructions for Change of Certificationā€‹

To request and submit changes to a licensed facility in California, complete the required application forms and submit them with all the identified supporting documents. The Centralized Applications Branch (CAB) will not process incomplete applications.

These instructions assist in preparing a End-Stage Renal Dialysis (ESRD) report of change application packet for a Change of Certification (CHOC). ā€‹ā€‹

Please read each required application form carefully and:

  • Provide all requested supporting documents
  • Retain a copy of the completed application forms and supporting documents ā€“ CAB may contact the applicant and will refer to the information providedā€‹

Review Process

CAB receives an application packet and assigns an application ID number in the Electronic Licensing Management System. A CAB analyst reviews the application packet to validate receipt of all the required forms and supporting documents. Application packets missing forms and/or supporting documents are incomplete and may result in a delay in processing. ā€‹

Submission of Applicationsā€‹

Submit completed application packets to:

          California Department of Public Health
          Licensing and Certification Program
          Centralized Applications Branch
          P.O. Box 997377, MS 3207
          Sacramento, CA 95899-7377

If you have any questions, please contact CAB at (916) 552-8632 or by e-mail at CAB@cdph.ca.gov.ā€‹

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