Ph: 702.236.6844
Fax: 702.844.8465
LTCMgtConsultants@gmail.com
nvltcmgtandconsult.com
COMPLIANCE
Consulting
Date
/
Month
/
Day
Year
Date
Client Name
*
Home Phone
Cell Phone
*
Email Address
*
example@example.com
Street
*
Please include Apt or Unit number
City
*
State + Zip
*
Facility Information
The questions that follow are about the potential or already established facility.
Street
*
type N/A if you haven't found a property yet.
City
State + Zip
Does this address have an HOA?
*
No
Yes
What type of Residential Care Facility are you trying to open?
*
Home for Individual Residential Care
Group Home
Assisted Living Facility
Other
Do you have an administrator?
*
No
Yes
If yes, please provide the administrator's name
Do you have a business license?
*
No
Yes
If yes, which issuing agency? Select all that apply.
City of Las Vegas
City of Henderson
Clark County
Other
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