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Adding a new affiliate location

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​​Thank you for choosing ABC for your facility accreditation needs.  To add your new affiliate location, please complete​ the information in the form below.  An email will be sent to you once the location has been added and linked to your primary location.  Please allow up to 48 hours for this process to be completed.  If you have any questions in the meantime, feel free to contact the ABC Accreditation department at 703-836-7114.

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Primary's Facility Id *


Primary Facility's Name *


Name of New Affiliate location *


Address Line 1 of New Affiliate *


Address Line 2 of New Affiliate


New Affiliate's City *


New Affiliate's State *


New Affiliate's Zip Code *


New Affiliate's Phone Number *


New Affiliate's Fax Number


New Affiliate's Email *


New Affiliate's Web Site


New Affiliate's EIN number *


New Affiliate's NPI number


New Affiliate's PTAN number


New Affiliate's Primary Contact Name *


New Affiliate's Primary Contact Email