(1) Application for a health care facility/service license accompanied by the required fee shall be made to the Department of Public Health and Human Services, Quality Assurance Division, Licensure Bureau, 2401 Colonial Drive, P.O. Box 202953, Helena, MT 59620-2953 upon forms provided by the department and shall include full and complete information as to:

(a) the name and address of the applicant if an individual, the name and address of each member if a firm, partnership, or association; or the name and address of each officer if a corporation;

(b) the location of the facility;

(c) the name of the person or persons who will manage or supervise the facility;

(d) the number and type of patients or residents for which care is provided;

(e) any information which the department may require pertaining to the number, experience, and training of employees; and

(f) information on ownership, contract, or lease agreement if operated by a person other than the owner.

(2) The fee for licensure is $20.00.

(3) Every facility shall have a distinct identification or name and shall notify the department in writing within 30 days prior to changing such identification or name, changing ownership, or relocating the facility.

History: 53-21-194, MCA; IMP, 53-21-194, MCA; NEW, 2009 MAR p. 1801, Eff. 10/16/09.