Renewal Application for License for Assisted Care Living Facility - health state tn 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of your facility and its license number. Ensure that the location details, including street, city, county, and zip code, are accurately filled out.
3. Provide contact information such as phone number, fax number, and a 24-hour emergency phone number. Don’t forget to include an email address for correspondence.
4. Indicate the total number of licensed beds and whether your facility has a secured unit. If applicable, specify the number of secured beds and if adult day care services or pet therapy is provided.
5. Complete the ownership section by checking the appropriate legal entity type and providing details about individual owners or partners. Include any accreditation information if applicable.
6. Finally, review all entries for accuracy before signing the application to verify compliance with Tennessee regulations.

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