NC DHHS DHSR/HCPEC 4502 2020-2026 free printable template
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Health Care Personnel Education and
Credentialing Section2709 Mail Service Center
Raleigh, NC 276992709
Division of Health Service
RegulationPhone: 9198553970
Fax: 9197339764
N.C. Department of Health
and
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How to fill out NC DHHS DHSRHCPEC 4502
How to fill out NC DHHS DHSR/HCPEC 4502
01
Obtain the NC DHHS DHSR/HCPEC 4502 form from the official website or local office.
02
Fill in the required personal information, including your name, address, and contact details.
03
Provide details about the organization or facility, including its name, address, and type of service offered.
04
Complete the section related to the services provided, ensuring compliance with state regulations.
05
Sign and date the form at the designated area, certifying that all information provided is accurate.
06
Submit the completed form to the appropriate DHHS office through mail or in-person delivery.
Who needs NC DHHS DHSR/HCPEC 4502?
01
Healthcare facilities seeking licensure or certification in North Carolina.
02
Individuals applying for permits related to health care services.
03
Organizations involved in the provision of community-based health services.
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What is NC DHHS DHSR/HCPEC 4502?
NC DHHS DHSR/HCPEC 4502 is a form used by the North Carolina Department of Health and Human Services Division of Health Service Regulation to report essential health care provider information.
Who is required to file NC DHHS DHSR/HCPEC 4502?
Certain health care facilities and providers in North Carolina are required to file NC DHHS DHSR/HCPEC 4502, typically those involved in the delivery of health care services.
How to fill out NC DHHS DHSR/HCPEC 4502?
To fill out NC DHHS DHSR/HCPEC 4502, you must provide accurate and complete information about the health care provider, including facility details, services offered, and ownership information. It is important to follow the instructions provided on the form.
What is the purpose of NC DHHS DHSR/HCPEC 4502?
The purpose of NC DHHS DHSR/HCPEC 4502 is to collect and maintain accurate data on health care facilities and providers in North Carolina to ensure compliance with state health regulations.
What information must be reported on NC DHHS DHSR/HCPEC 4502?
The information that must be reported on NC DHHS DHSR/HCPEC 4502 includes the name of the facility, address, type of services provided, ownership details, and any relevant licensing information.
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