Skip Navigation LinksGACH-APH-License-Consolidation-Provider-Checklist

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

License Consolidation

Required Documents

Online Application PDF Form
  • Embedded and generated by online system
Licensee/Business Entity Information 
  • Organizational chart displaying the following information: applicant’s owners, directors, board members, corporate officers, LLC members/managers, and partners 
    • The organizational chart needs to include all entities that have 5% or more direct and indirect ownership.​
Helpful Tip
  • ​Submit a Change of Certification (CHOC) application to update Medi-Cal/Medicare, if applicable.



Page Last Updated :