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

Contact Us

Phone: (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€‹

General Acute Care Hospitals and Acute Psychiatric Hospitals

License Reactivation

Required Documents

Online Application PDF Form
  • Embedded and generated by online system
Facility Information
  • ā€‹ā€‹Department of Health Care Access and Information (HCAI) Certificate of Occupancy/Approval to repopulate
  • STD 850ā€‹ (PDF)ā€‹ā€‹ form - Fire Safety Inspection Request or a document that contains the fire inspectorā€™s contact information (name, email, and address)
  • Floor plan that includes a schematic of the room(s) (if construction has occurred)
ā€‹Helpful Tips:
When the facility is approved for re-occupancy:
  • ā€‹Submit a Change of Certification (CHOC) application for Medi-Cal and Medicare Certification, if applicable.
  • ā€‹ā€‹Submit a Change of Administrator (CHOA) application for Administrator updates.
  • Submit a Change of Director of Nursing (DON) application for Director of Nursing updates.
  • Floor plan that includes a schematic of the room(s)
  • ā€‹Submit a Change of Governing Board (CHGB) application if there are any updates to the governing board.ā€‹
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