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Rehabilitation Agency Service Provider Application

Federal Medicare Regulations

Application Materials

After review and acceptance of the application materials and notification from CMS of the approval of the CMS-855A, the department will conduct a survey before recommending the agency for Medicare certification.

Mail completed forms to:
Please note change of address
Pennsylvania Department of Health
555 Walnut St.
7th Floor, Suite 701
Harrisburg, PA 17101

Call 717-783-1379