Become a Partner Facility

Tell us about your organization and we’ll reach out within a few business days. A TSR administrator reviews every application and invites approved facilities into the Partner Portal, where you complete your full credentialing (licenses, programs, fee schedule, BAA & 42 CFR Part 2 acknowledgments).

Organization Identity

Legal entity, EIN, and contact information for your facility.

Legal organization name*

DBA (if different)

Year founded

EIN*

Federal Employer Identification Number, e.g. 12-3456789.

NPI (optional)

10-digit National Provider Identifier, if applicable.

Organization type*

Program description*

At least 50 characters. Services offered, populations served, what sets your program apart.

Website

Primary Contact

Name*

Title / role*

Email*

Phone*

Headquarters Address

Street address*

City*

State*

ZIP*

Step 1 of 5

Already a partner? Sign in here.