Department Updates - DHCS - CA 2026

1. Click ‘Get Form’ to open the Department Updates - DHCS - CA in the editor.
2. Begin by entering your legal name as listed with the IRS in the designated field. Ensure accuracy to avoid processing delays.
3. Provide your business name if it differs from your legal name. If using a fictitious business name, attach the necessary documentation.
4. Fill in your primary business telephone number and ensure it is a valid contact for correspondence.
5. Complete the business address section accurately, including street number, city, and ZIP code. Avoid using P.O. boxes unless specified.
6. Indicate any enrollment actions requested by checking the appropriate boxes, such as 'New provider' or 'Change of business address'.
7. Attach all required documents, including proof of insurance and NPI verification, ensuring they are legible and correctly formatted.

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