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*Important: Facilities must mail documents identified below along with the application fee to:

Mailing Address:
Ohio Department of Health
Health Care Facility Program
Attn:  Revenue Processing - 3600
P.O. Box 45278
Columbus, OH 43215

Telephone: (614) 644-2727

Use the following charts as guidelines when applying, renewing or amending a license.
The department will mail a renewal notice to each health care facility approximately 60 days prior to the expiration of the license.  All renewal applications must be submitted online by the end of the expiration month.


Initial Application

Renewal Application 

Amendment Application 



Federal Tax I.D. #

Application Fee 



$150 (when applicable) 

Confirmation Printout to be mailed to ODH

Fire Inspection Report (within last 12 months) 

(address change or building renovation only) 

Use and Occupancy Report 

(address change or building renovation only) 

Notarized Affidavit (required when someone other than an owner signs application) 


Renewal Notice Mailed to you.




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Last Reviewed: 5/16/18