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Applications for Licensing and/or Certification of 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” Opens new browser windowletter.

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:

 
 
Last modified on: 7/31/2013 4:13 PM