Get Application For A License To Operate An Assisted ... - Nd

This guide provides essential steps for completing the application for a license to operate an assisted living facility in North Dakota. It aims to assist users in navigating the form efficiently and accurately.

Follow the steps to successfully complete your application

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide the assisted living facility information. Fill in the name, street address, city, state, and ZIP code of the facility. Include the mailing address if it differs from the physical address.
3. Enter the contact person’s details, including their title, telephone number, email, and fax number. This information is crucial for future communication regarding the application.
4. Specify the type of application by selecting either 'Initial' or 'Renewal'. Include the number of living units that your facility can accommodate.
5. Indicate if the assisted living facility specializes in dementia or Alzheimer's care by marking 'Yes' or 'No'.
6. Answer questions regarding any changes in legal entities and ownership over the last twelve months by selecting the appropriate options.
7. Provide details about the legal operator and owner of the assisted living facility, including their exact names, mailing addresses, and taxpayer identification numbers.
8. List the services available to tenants at the facility. Indicate which services are provided directly or coordinated through other entities.
9. Complete the signatures and affidavit section. Ensure that the application is signed by authorized individuals as outlined in the form instructions.
10. Attach the required documents, including a payment for the application fee, and any other necessary agreements or brochures. Double-check that all required items are included.
11. Once finished, review the completed application for accuracy. Save your changes, download a copy for your records, print the form, or share it as needed.

Complete and submit your application online to begin the licensing process for your assisted living facility.