Opening a Physical Location: What’s New vs. What Carries Over
Last updated: September 16, 2026
If you’re running a telehealth ABA practice and thinking about adding a physical, center-based location, most of your existing setup carries over — your LLC, EIN, NPI, CAQH profile, and HIPAA policies don’t change. This article maps what’s genuinely new so you know where to focus.
Carries over, mostly unchanged:
Your legal entity, EIN, business bank account
Your organizational NPI — you’re updating it with a new address, not getting a new one
Your CAQH profile — you add a location, you don’t start over
Your core HIPAA policies and mandatory-reporter training
BACB supervision rules and CPT billing codes (97151, 97153, 97155, etc.)
Genuinely new:
Finding, zoning-checking, and building out a physical space — see “Market Research and Budgeting for a New Physical Site” and “Finding and Building Out a Physical Space”
State facility-level licensing, separate from your individual BCBA/RBT licenses — see “Facility-Level State Licensing for In-Person ABA Clinics”
Re-enrolling with every payer for the new address, including a Medicaid site visit — see “Enrolling a New Physical Location With Payers”
Hiring and managing in-person staff — see “Hiring and Managing In-Person Staff at Your New Location”
Updating your business insurance — see “Insurance for Your New Physical Location”
New day-to-day operations (in-person intake, physical safety plans) — see “Day-to-Day Operations at a Physical Clinic”
NOTE: Payer location enrollment is usually the long pole, not construction. Flag your signed lease to Alpaca the day you sign it — see “Enrolling a New Physical Location With Payers.”
A Master Timeline
The phases below are directional, not a committed schedule — actual duration depends heavily on your specific state, payers, and building, and can run shorter or longer than a first read suggests.
Phase | What’s happening |
|---|---|
Kickoff | Start market research and the financial-model addendum, incl. foreign-qualification filing if it's a new state; start looking for space. |
Lease signed | Sign a lease — the moment you have a firm address, flag it to Alpaca to start payer location enrollment and begin facility-licensing inquiries in parallel — don’t wait for build-out. |
Build-out | Build-out, inspections, Certificate of Occupancy. Facility licensing application processed (timeline varies a lot by state). Hiring/staffing conversation). Business insurance updates. |
Payer enrollment (runs in parallel with build-out) | Payer location enrollment across Medicaid + commercial payers — this is your likely long pole, especially the Medicaid site visit. |
Soft launch | Soft launch once payer location enrollments confirm active. |
Opening | Opening day and first 90 days. |
The one thing to internalize: payer location enrollment (Part 4) does not inherit your existing telehealth credentialing — it resets a clock of its own, and the Medicaid site visit is scheduled by the state, not by you. Flag your lease to Alpaca the day you sign it.
If You Only Remember 4 Things
Being credentialed for telehealth does not cover the new physical address. Each payer has to add the new location before you can bill for in-person sessions there, and Medicaid will likely require a site visit your telehealth enrollment never needed. Alpaca runs this process — you just plan your opening around its timeline.
Zoning and building permits don’t care that you’re an established business — treat the physical-space search exactly like a first-time owner would, and confirm zoning before signing a lease.
Facility-level state licensing is separate from your individual BCBA/RBT licenses, and several states (North Carolina and newly Colorado) require it explicitly for in-person sites.
Flag your signed lease to Alpaca the day you sign it — payer location enrollment is likely your longest pole, and it runs on the payer’s/state’s schedule, not yours.
Questions? Reach out to your Alpaca support team.