Assisted Living Facility Applications

Please ensure you are using the current Assisted Living Facility (ALF) License Application (DSHS 10-591.  Effective February 1, 2018 applications received with a revision date other than 12/2017 in the bottom left hand corner will be rejected.

The following are needed prior to applying for a license and/or contract:

Federal Employer Identification Number (EIN) - A copy of the IRS SS-4 form showing the assigned EIN number will be accepted as verification an EIN was obtained. For more information on EINs, visit https://www.irs.gov/

Unified Business Identifier (UBI) - A copy of the Washington State business license showing that the trade name has been registered with the Department of Revenue. For more information on UBIs, visit https://dor.wa.gov/doing-business

Certificate of Incorporation or Certificate of Formation issued by the Secretary of State.  For more information on this registration, visit https://www.sos.wa.gov/corps/