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Health Care Facility LIcensing and Certification

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For application status requests, please include the following in your email:

  • Application ID (if applicable)
  • Name of Facility or Agency
  • License or Facility/Agency # (if applicable)
  • Address
  • Facility or Provider Type
  • Date Documentation Sent
  • Contact Number

Intermediate Care Facilities for the Developmentally Disabled-Nursing (ICF/DD-N)
Change of National Provider Identifier Application Packet

A State license is required to operate as an Intermediate Care Facilities for the Developmentally Disabled-Nursing (ICF/DD-N) facility in California. An ICF/DD-N means "a facility with a capacity of 4 to 15 beds that provides 24-hour personal care, developmental services, and nursing supervision for persons with developmental disabilities who have intermittent recurring needs for skilled nursing care but have been certified by a physician and surgeon as not requiring continuous skilled nursing care. The facility shall serve medically fragile persons with developmental disabilities or who demonstrate significant developmental delay that may lead to a developmental disability if not treated," pursuant to Health and Safety Code (HSC) section 1250(h).

To report a Change of National Provider Identifier (NPI), you must compete 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 and furnishing the NPI to the State agency.

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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