Transcription of In-Home Services License Application Packet
{{id}} {{{paragraph}}}
Example: confidence
In-Home Services License Application Packet
DOH 505-052 June 2021In- home Services License Application PacketContents: 1. 505-052 ..Contents List / Mailing Information ..1 Page2. 505-053 .. Application Instructions Checklist ..3 Pages3. 505-109 .. License Page4. 505-051 .. In-Home Services Application ..5 Pages5. 505-055 ..Disclosure Statement ..1 Page 6. 505-137 ..Full-Time Equivalent (FTE) Worksheet ..2 Pages7. RCW/WAC and Online Website Links ..1 Page In order to process your request:Mail your Application with initial documentation and your check Send other documents not sent or money order payable to: with initial Application to:Department of Health In-Home Services Credentialing Box 1099 Box 47877 Olympia, WA 98507-1099 Olympia, WA 98504-7877 Contact us: 360-236-4700(This page intentionally left blank.)
In-Home Services Agency License Application This is for: F New F Change of Ownership F Amended F Renewal Check One F Limited Partnership F Municipality (City) F Municipality (County) F Non-Profit Corporation F Partnership F Association F Corporation F Federal Government Agency F For-Profit F Limited Liability Company
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: