Application for License to Operate a Birth Center

Name and Location of Facility
Must be exactly as name appears on legal documents.
Do you have a DBA (Doing Business As)?
Contact Information
Administrator
Physical Address
Mailing Address
Is your mailing address different from the address above?
Capacity and Classification of Facility
Select classification for which application is made:
Select days and list hours of operation:
Accreditation
Are you accredited?