Intermediate Care Facilities for the Developmentally Disabled-Continuous Nursing (ICF/DD-CN)
Change of National Provider Identifier Application Packet
A State license is required to operate as an Intermediate Care Facilities for the Developmentally Disabled-Continuous Nursing (ICF/DD-CN) facility in California. An ICF/DD-CN means "a homelike facility with a capacity of four to eight, inclusive, beds that provides 24-hour personal care, developmental services, and nursing supervision for persons with developmental disabilities who have continuous needs for skilled nursing care and have been certified by a physician and surgeon as warranting continuous skilled nursing care. The facility shall serve medically fragile persons who have developmental disabilities or demonstrate significant developmental delay that may lead to a developmental disability if not treated," pursuant to Health and Safety Code (HSC) section 1250(m).
To report a Change of National Provider Identifier (NPI), you must complete the required application packet. Refer to Title 42 of the Code of Federal Regulations (CFR) 424.506 and CFR 431.107 (b)(5)(i) for information regarding NPI enrollment requirements.
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