Application for License to Operate a Chemical Dependency Treatment Facility

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
Accreditation
Inpatient Chemical Dependency Treatment Facility Accreditation under SDCL 34-20A:
Period of Accreditation