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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

Chronic Dialysis Clinic and
End-Stage Renal Disease Dialysis Facility
Change of Name Application Packet

A State license is required to operate a Chronic Dialysis Clinic (CDC) in California. A CDC means "a clinic that provides less than 24-hour care for the treatment of patients with end-stage renal disease, including renal dialysis services," pursuant to Health and Safety Code (HSC) section 1204(b)(2). A CDC may also apply for certification as an End-Stage Renal Disease (ESRD) facility. An ESRD facility is an entity that provides outpatient maintenance dialysis services, or home dialysis training and support services, or both, pursuant to Title 42 Code of Federal Regulations (CFR) section 494.10. 

To report a Change of Name, you must complete the required application packet. Refer to HSC sections 1200 through 1245 for information regarding licensure requirements. Refer to 42 CFR Part 494, Subpart A for the Conditions For Coverage For End-Stage Renal Disease Facilities.

How to Apply

An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The application packet contains the required forms in one location. The provider checklist identifies the required forms and supporting documents needed to apply for licensing and certification. The provider instructions are a resource to guide you through the process. The Sample Application Packet is a visual aid that displays a sample of the completed forms contained in the application packet.

Please refer to the following links to get started:

Where to Submit Applications

Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.

          California Department of Public Health
          Licensing and Certification Program
          Centralized Applications Branch
          P.O. Box 997377, MS 3207
          Sacramento, CA 95899-7377

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