Healthy Communities

HFS-Applications for New Providers and Applications for Change of Ownership

Requests for New Provider Packets or Change of Ownership Packets should be submitted via mail, email or fax. Please be sure to identify which type Provider Packet (New or Change of Ownership) is required.

 

New Provider Packet: This packet will contain forms to begin the process to become licensed and/or Medicare Certified and must be submitted to the Health Facility Services section of ADH. 

 

Change of Ownership Packet: This packet will contain forms for existing providers needing to notify ADH’s Health Facility Services section of a change in ownership.

 

Types of Providers Licensed by Health Facility Services or Certified by Medicare:

Office Address Phone Fax
Health Facility Services 5800 W. 10th St., Suite 400
Little Rock, AR  72204
501-661-2201 501-661-2165

 

Public Health Accrediation Board
Arkansas Department of Health
© 2017 Arkansas Department of Health. All Rights Reserved. | www.healthy.arkansas.gov
4815 W. Markham, Little Rock, AR 72205-3867 | 1-800-462-0599