Application for License to Operate a Hospital

Name and Location of Facility
Must be exactly as name appears on legal documents.
Do you have a DBA (Doing Business As)?
Contact Information
Physical Address
Mailing Address
Is your mailing address different from the address above?
Capacity and Classification of Facility
Include psychiatric, intensive care, self-care, postpartum (LDRP) and coronary care units.
DO NOT include bassinets, labor or surgical recovery rooms.
Does the facility have swing beds?
Select type of institution for which application is made:
Select services that the institution provides:
Are you accredited?