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Health Care facility Licensing and Certification

 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

Primary Care Clinic (Community Clinic, Free Clinic) Licensing Application and Checklist

The following information and checklist provides directions for completing an application package to request:

  • a state license as "community" or "free" primary care clinic (PCC),
  • certification as a Medicare and/or Medi-Cal provider, and/or
  • reporting changes in clinic information.

Table of Contents

  • Licensure - Application Forms
    • PCC - Establishment of a new (Initial)
    • PCC - Change of Ownership (CHOW)
    • PCC - Mobile Clinic
    • PCC - Mobile Clinic CHOW
    • Affiliate Clinic
    • Affiliate Clinic CHOW
    • Affiliate Mobile Clinic
    • Affiliate Mobile Clinic CHOW
    • Consolidated License
    • Consolidated Mobile Clinic
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