Become a Member - Licensed Facility Membership dues cover 9/1/2021 through 8/31/2022 Licensed facility dues are $40 for the first home and $5 for EACH additional home or facility. Is this a new listing, or are you renewing?* I'm new here! I'm renewing my membership! Facility Name* Do you need to update your listing?*Member listings can be found here - please find your listing and check it over. No Yes Facility License Number* Facility Description*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address(If different from above) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person* First Last Phone Number*Fax NumberEmail Address* Website AFC Info*Choose all that apply. Regular AFC Alzheimer's Assisted Living CARF Accredited CMH Certified D.D. Elderly Family Care GHS Certified Hospice Large Group Long Term M.I. Medium Group Memory Care Mental Illness Physical Disabilities Rehab Respite Care Secured Small Group Smoking Allowed Special Licensing Specialized Behavioral AFC Specialized Contract Specialized Residential T.B.I. Wheelchair Accessible Age Range Served* Genders Served* Male Female Payments Accepted*Choose all that apply. Auto Insurance GHS Contract Medicaid Medicare Private Pay SSI Veterans' Assistance Valley Area Aging Assistance Long Term Care Insurance CMH Contract Workman's Comp Other (list below) Other Payments AcceptedWhere would you like your home listed?* Printed Directory Website AFC Providers - Licensed Facility Membership*Would you like to add another Licensed Home?*Additional homes are $5 each No Yes Add a Licensed Home Facility Name Actions Edit Delete There are no Licensed Homes. Add Licensed Home Maximum number of licensed homes reached. Additional Licensed Homes* Price: $5.00 Total $0.00 Credit CardCard Details Cardholder Name
