2024-2025
PROVIDER LICENSE
APPLICATION RENEWAL
SUBMISSION DEADLINE
May 17, 2024
Select the appropriate application below.
Annual Renewal License 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
Freestanding Diagnostic Testing Center Renewal Application
Home Health Agency Renewal Application
Hospice Renewal Application
Hospital Renewal Application
Intermediate Care Facility for Individuals with Intellectual Disabilities Renewal Application
Medical Assistance Renewal Application
Nursing Home Renewal Application
Psychiatric Hospital Renewal Application
Rehabilitation Facility Renewal Application
Rehabilitation Hospital Renewal Application
Renal Dialysis Center Renewal Application
Ancillary Location Form- Hospitals
Ancillary Location Form- Other Provider Types
For new providers, changes in ownership, or other
changes please contact our office at 307-777-7123.