Newly Licensed/Pending License/Single License Form

Membership Types

You will be prompted to select your membership type and dues rate after clicking Submit below. Membership types and rates are as follows:

  • Newly Licensed Provider - $500 
  • Pending License Provider - $500
  • Single License Provider
    • Tier 1 - Single License: Annual Revenue less than $1 million - $863
    • Tier 2 - Single License: Annual Revenue $1-3 million - $1,438
    • Tier 3 - Single License: Annual Revenue $3,000,001-5 million - $2,013
    • Tier 4 - Single License: Annual Revenue $5,000,001-7 million - $2,588
    • Tier 5 - Single License: Annual Revenue $7,000,001 - 9 million - $3,088
    • Tier 6 - Single License: Annual Revenue greater than $9 million - $3,588

 Allied (Not Home Care of Hospice Provider)
 HHAO (Home Health Aide Only)
 HHAS (Home Health/Skilled)
 Hospice
 PASA (Personal Assistance Service Agency)

Agency Primary Representative

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Members may add as many staff as you wish per paid member license.
Multi-licensed Members: If you have remote support office staff employed by your company at a non-licensed location and wish for them to be included in DAHCC communications, you may include them as staff of your primary license membership.