2023-2024
PROVIDER LICENSE
APPLICATION RENEWAL
SUBMISSION DEADLINE
May 15, 2023
Select the appropriate application below to download.
2023 Renewal Application Instructions
Adult Day Care Center Renewal Application
Adult Foster Care Home Renewal Application
Assisted Living Facility Renewal Application
Ambulatory Surgical Center Renewal Application
Birthing Center Renewal Application
Boarding Home Renewal Application
Critical Access Hospital Renewal Application
End Stage Renal Dialysis Renewal Application
Freestanding Diagnostic Testing Center Renewal Application
Home Health Agency Renewal Application
Hospital Renewal Application
Hospice Renewal Application
ICF/IID Renewal Application
Medical Assistance Facility Renewal Application
Nursing Care Facility Renewal Application
Psychiatric Hospital Renewal Application
Rehabilitation Hospital Renewal Application
Rehabilitation Facility Renewal Application
For new providers, changes in ownership, or other
changes please contact our office at 307-777-7123.