Get Initial Provider Application - Virginia Department Of Behavioral ... - Dbhds Virginia

Filling out the Initial Provider Application for licensing with the Virginia Department of Behavioral Health and Developmental Services can be an important step for organizations looking to provide critical services. This guide is designed to support you through each section of the application process, ensuring a smooth and efficient experience.

Follow the steps to successfully complete your Initial Provider Application

1. Use the ‘Get Form’ button to access the Initial Provider Application and open it for completion.
2. Begin with the Applicant Information section. Provide your organization's name, mailing address, and contact details. Make sure to include the names of all owners and their ownership percentages.
3. In the Organizational Structure section, select whether your organization is a non-profit or for-profit entity and indicate its governing structure, such as whether it is an individual proprietorship, corporation, or partnership.
4. Complete the Applicant Parent Company Information section if applicable. Provide the name and address of the parent company, as well as the contact details of key individuals within that organization.
5. Detail the Service Type by selecting the appropriate service you are applying for. Remember, new applicants may only choose one service type for the initial application.
6. Furnish the Service Information, which includes the Service Director's details and client demographics that apply to your organization.
7. In the Location section, fill out the location name, address, and contact information for the location manager. Include directions to your facility if necessary.
8. Identify the records' locations for financial, personnel, and residents’ information. Provide the addresses for each category.
9. Make sure to prepare and attach all required documents listed in the application, such as a working budget, evidence of financial resources, and a completed organizational structure.
10. At the end of the application, the authorized individual must sign the Certificate of Application, ensuring that all supplied information is accurate and complete.
11. Finally, save the completed application, and proceed to download, print, or share it as needed. Ensure to follow submission guidelines provided in the documentation.

Complete your Initial Provider Application online today to begin providing essential services.