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Licensing and Certification Program

Nursing Home Administrator

The Nursing Home Administrator Program (NHAP) is governed by the Health and Safety Code Sections 1416 through 1416.84 and must assure that the health, safety, security, and rights of the Skilled Nursing Facility (SNF) and Intermediate Care Facility (ICF) residents are safeguarded by setting standards for licensing of nursing home administrators (NHAs), administering a training program for NHAs, testing and issuing licenses, and administering an enforcement program for disciplinary action against NHAs.
NHAP continues to strive for excellence in ensuring that California Nursing Homes are managed by qualified professional NHAs.

Verification of Nursing Home Administrator License Link

Important Dates

Nursing Home Administrator Forms  

AIT Forms

  • CDPH 501 Administrator in Training (AIT) Evaluation Report
  • CDPH 502 Application for AIT Program
  • CDPH 502A Application for Educational Waiver for AIT Program
  • CDPH 507 Modification of Administrator in Training Hours Request
  • CDPH 526 AIT Program Application for Re-Training

Examination Forms

  • CDPH 503 Application for Nursing Home Administrator State Examination
  • CDPH 505 Application for Nursing Home Administrator National Examination
  • CDPH 520 Re-Examination Application for Nursing Home Administrator State Examination
  • CDPH 521 Re-Examination Application for Nursing Home Administrator National Examination
  • CDPH 523 Special Accommodation Request for Examination
  • CDPH 524 Master’s or Reciprocity Application for Nursing Home Administrator Examination

License Forms

  • CDPH 506 Application for Nursing Home Administrator License
  • CDPH 525 Application for Provisional License

Preceptor Forms

  • CDPH 516 NHAP Preceptor Training Registration Form

Continuing Education Forms

  • CDPH 508 Application to Become a Provider of Continuing Education
  • CDPH 515 Preceptor Continuing Education Credit Application
  • CDPH 518 Provider Request for Course Approval
  • CDPH 519 Provider Request for Course Renewal
  • CDPH 522 Request for Provider Renewal

Renewal/Change of Facility/Replacement License Forms

  • CDPH 510 Declaration and Request for Replacement License
  • CDPH 514 NHA/Facility Profile Sheet

Live Scan Forms

Contact Us:

Mailing Addresss:

Nursing Home Administrator Program
P.O. Box 997416, MS 3302
Sacramento, CA 95899-7416

Phone Number: (916) 552-8780
Fax Number: (916) 552-8777

Email: NHAP@cdph.ca.gov

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