Skip Navigation LinksGACH-APH-CHST-CHIO-Provider-Checklist

HEALTH CARE FACILITY LICENSING AND CERTIFICATIONā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹

Contact Us

hone: (916) 552-8632
Email: CAB@cdph.ca.gov     

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 Numberā€‹ā€‹ā€‹ā€‹ā€‹ā€‹
    ā€‹
ā€‹ ā€‹

General Acute Care Hospitals and Acute Psychiatric Hospitals

Changā€‹ā€‹e of Stock Transfer/Indirect Ownership

Required Documents

Online Application PDF Form
  • Embedded and generated by online system
Stock Purchase Information 
  • ā€‹Stock Purchase Agreement that is signed by the buyer and seller
Construction/Other Documentation
  • Organizational chart displaying the following information: applicantā€™s owners, directors, board members, corporate officers, LLC members/managers, and partners 
    • The organizational chart needs to include all entities that have 5% or more direct and indirect ownership .
  • Purchase Agreement
ā€‹ā€‹
ā€‹ā€‹
Page Last Updated :