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Licensing and Certification Program

Applications for a Skilled Nursing Facility or Intermediate Care Facility

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.  These documents must be submitted with your completed application.  The required information and instructions are listed on the checklist contained in the Skilled Nursing Facility or Intermediate Care Facility Application Request Letter and Instructional Checklist (PDF) letter.

Skilled Nursing Facility or Intermediate Care Facility 

Required Forms to be Licensed:

Nursing Facility or Intermediate Care Facility 

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

Skilled Nursing Facility

Required Forms to be Certified with Medicare:

Contact Us:

Phone: (916) 552-8632

Email: CAB@cdph.ca.gov

Staff will respond to your inquiry within 48 hours.

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