Skilled Nursing Facilities Form

Thank you for your interest in becoming an L.A. Care Health Plan network provider. This form is necessary to perform an initial assessment to confirm your eligibility for participation.
 

Organization Phone Number
Are you Medicare Certified?:
Are you Medicare Certified? (Credentialing Requirement):
Are you Currently on the OIG exclusion list of DHCS suspended & ineligible list?:
Point of Contact Phone Number
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