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The National Center for Assisted Living American Healthcare Association

CHCA Facility Membership Application


Download Facility Membership Application Or fill in the application form below.

  Contact Information                                              3/11/2010
  Your IP Address
  Name of Facility:  
  Administrator:  
  Owner/Corporation Name:  
  Phone Number : Ext   (111-111-1111:111)
  Fax Number (111-111-1111)
  Email  
  Company Address  
City:    
State:       Zip:     

  Contact Person:


  

  Contact Person's Phone Number:

  
  Number of beds NCF:
  Assisted Living:
  Multifacility:
  Independent Owner:
  For Profit Non-Profit:
  Licensed NCF Beds: Call for special pricing.
  Assisted Living: Call for special pricing.
  



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Phone: 303-861-8228 Fax: 303-839-8068
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