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New Provider Packets
New providers must request a new provider packet from Health Facility Services. This packet will contain all required packet from Health Facility Services. This packet will contain all required forms to start the process to become Licensed and/or Medicare Certified.
- Hospitals
- Home Health Agencies
- Hospices
- Outpatient Surgery Centers/Ambulatory Surgery Center
- Psychiatric Hospitals
- Rehabilitation Hospitals
- Abortion Clinics
- Alcohol/Drug Abuse Units
- Free-Standing Birthing Centers
- Invitro Fertilization Facilities
- Infirmaries
- Private Care Agencies
- Recuperation Centers
- Outpatient Psychiatric Centers
Change of Ownership Packets
- Hospitals
- Home Health Agencies
- Hospices
- Outpatient Surgery Centers/Ambulatory Surgery Center
- Psychiatric Hospitals
- Rehabilitation Hospitals
- Abortion Clinics
- Alcohol/Drug Abuse Units
- Free-Standing Birthing Centers
- Invitro Fertilization Facilities
- Infirmaries
- Private Care Agencies
- Recuperation Centers
- Outpatient Psychiatric Centers
Request for New Provider Packets or Change of Ownership Packets should be submitted via mail, or fax. Please be sure to identify which type of provider packet(s) is required.
| Office | Address | Phone | Fax | | Health Facility Services | 5800 W. 10th Street, Suite 400
Little Rock, AR 72204 | 501-661-2201 | 501-661-2165 |
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