| NOTE:
Before starting the application have available your
Agency address, phone number and fax and your EIN
and NPI numbers |
Go to www.chapinc.org
Click on Accreditation Process
Click on Application for Accreditation
In Second Paragraph Click on CLICK HERE |
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Page
1
Enter EIN Number
Enter name and email address
Create password
Click on Create Account
Page 2
Enter Agency name
CEO (you) name and title
CHOOSE Single location
Branches -0 Sub-Units 0
CHOOSE - Independent Free Standing
CHOOSE Proprietary For Profit
Is Parent Applying Answer YES
Enter Street Address, Name of Contact (You), phone
and fax
Page 3
Enter Agency name and address
CHOOSE - Main Office
Enter NPI number
Leave Medicare BLANK
Leave Medicaid BLANK
Leave License BLANK
Enter Date that is ten days prior to the date
of the Application
MILES TO PARENT -- ENTER 0
Page 4
CHOOSE CORE
CHOOSE HOME HEALTH
Page 5
CENSUS 0
Accreditation with No Medicare accreditation
Total Admissions O
Page 6
Review Information and Submit
Within a couple of hours you will receive an EMAIL
acknowledgment. Save a copy and
forward it to your contact at 21st Century. Print
it out and mail it to the address given in
the acknowledgment with a check for $500.00
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