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health care facility Licensing and Certification

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Phone: (916) 552-8632

Staff will respond to your inquiry within 48 hours.

Applications for an Intermediate Care Facility for the Developmentally Disabled

The following forms and documents are required for licensure and/or certification. 

In addition to the forms below, you are required to submit additional documents for a change of ownership plus information regarding your Program Plan and Consultants. These documents must be submitted with your completed application. The required information needed and instructions are listed in the checklists contained in the Application Request for Intermediate Care Facilities for the Deveopmentally Disabled webpage.

Intermediate Care Facility/Developmentally Disabled,
Intermediate Care Facility/Developmentally Disabled-Habilitative, &
Intermediate Care Facility/Developmentally Disabled-Nursing

Required Forms to be Licensed:

Required Forms to be Certified with Medicaid/Medi-Cal:

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