Facility Information
Please fill out this form to register your community with Artisan Senior Placement
Facility Name *
Facility Address *
Address (line 2)
City, State *
Zip Code *
Email *
Website
Phone (xxx-xxx-xxxx) *
Fax Number (xxx-xxx-xxxx)
Facility Care Type *
Required
Room Types *
Required
Rate ($) Range- Semi-Private- Shared Bath
Rate ($) Range- Private Room- Shared Bath
Rate ($) Range- Private Room- Private Bath
Rate ($) Range- Studio Suite
Rate ($) Range- 1 Bedroom Suite
Rate ($) Range- 2 Bedroom Suite
Rate ($) Range- 3 Bedroom Suite
2nd Person/Same Room
Security Fee Amount
Ambulation and Transfer Accepted
Incontinence Needs Accepted
Special Diets
Smoking/Alcohol
Clear selection
Pets
Clear selection
Professional Staff Available *
Required
Staffing Patterns
Staffing Ratio- Day
Staffing Ratio- Night
Cognitive Levels Accepted
Behaviors Accepted
Health Related Care and Services
Amenities Offered
Are you a Licensed Medicaid Facility?
Clear selection
What is the Accepted Spend Down Periods for Medicaid?
Submit
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