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 Contact Us

Phone: (916) 552-8632

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 Reactivation

Required Documents

Online Application PDF Form
  • Embedded and generated by online system
Facility Information
  • Department of Health Care Access and Information (HCAI) Certificate of Occupancy/Approval to repopulate
  • STD 850 (PDF)​​ form - Fire Safety Inspection Request or a document that contains the fire inspector’s contact information (name, email, and address)
  • Floor plan that includes a schematic of the room(s) (if construction has occurred)
​Helpful Tips:
When the facility is approved for re-occupancy:
  • ​Submit a Change of Certification (CHOC) application for Medi-Cal and Medicare Certification, if applicable.
  • Submit a Change of Administrator (CHOA) application for Administrator updates.
  • Submit a Change of Director of Nursing (DON) application for Director of Nursing updates.
  • Floor plan that includes a schematic of the room(s)
  • Submit a Change of Governing Board (CHGB) application if there are any updates to the governing board.​
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