Requirements for Adding an Additional Home Care Site

This process will only apply if you have a licensed agency.

The following is a list of the necessary items that are needed in order to apply for an additional site.

  1. A letter stating that you are adopting policies and procedures from your existing licensed site.
  2. Identify the name, address and license number of the existing licensed agency.
  3. A completed licensure application (PDF, 56 KB) signed and dated.
  4. $560.00 licensure fee.
  5. A copy of an executed lease for the premise of the new site.
  6. Agency Director qualifications must be submitted for the additional site (proof that the agency director for the additional site meets the qualifications 10A NCAC 13J.1001 (b))

All of the above items must be submitted in their entirety for review. If all items listed above are not submitted together, the information will be returned for completion.