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HEALTH CARE FACILITY LICENSING AND CERTIFICATION​​​​​​

 Contact Us

Phone: (916) 552-8632
Email: CAB@cdph.ca.gov     

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

  • Name of Facility or Agency
  • License or Facility/Agency # (if applicable)
  • Address
  • Facility or Provider Type
  • Date Documentation Sent
  • Contact Number​​​​​​

General Acute Care Hospitals and Acute Psychiatric Hospitals

Change of Facility Name

Required Documents

Online Application PDF Form
  • Embedded and generated by online system
Certification Documents 
  • DHCS 9098​ (PDF) form​ - Medi-Cal Provider Agreement​​
  • Copy of the resolution from the Board of Directors or a copy of the meeting minutes approving the name change
Helpful Tips
  • If you are requesting to change the name of an outpatient clinic, submit a Change of Service (CHOS) application.​
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