Contacts
Division of Health Care Facility Licensure and Certification
The Details
What you need
You will need to provide the following information in the Application for Change of Location
- Agency Registration Number
- Agency Name
- Office address prior to move
- Office address after move
- New telephone and fax numbers
- Start date for the new address
Fees
Please submit one check for all location changes, and make it payable to "Commonwealth of Massachusetts."
| Name | Fee | Unit |
|---|---|---|
| Change of location | $100 | for each location change |
How to change
- Download and complete the Application for Change of Location (DOCX)
- Mail completed application and check for fee payment(s) to:
Licensure Coordinator
Department of Public Health, Division of Health Care Facility Licensure and Certification
67 Forest Street
Marlborough, MA 01752
Downloads
Open DOCX file, 31.84 KB,
Application for Change of Location
(English, DOCX 31.84 KB)
Contact
Address
67 Forest St., Marlborough, MA 01752