Petition for retired nursing home administrator status

What you need   for Petition for retired nursing home administrator status

You are eligible to submit a petition for retired status, if you:

• Meet the eligibility requirements in 245 CMR 3.07(2)
• Have a license that is not surrendered, suspended, or revoked at the time of the petition
• Demonstrate, to the board's satisfaction, that you intend to permanently retire from active practice in the Commonwealth and in all other jurisdictions

You will also need your:

• License number
• Address
• Telephone number
• Email address
• Date of birth

How to submit   Petition for retired nursing home administrator status

By mail +

1. Download and complete the form, found below
2. Mail completed form to:

   
   Board of Registration of Nursing Home Administrators
   250 Washington Street,
   Boston, MA 02108

By fax +

1. Download and complete the form, found below
2. Fax completed form to (617) 973-0980

Downloads   for Petition for retired nursing home administrator status

Open DOCX file, 37.04 KB,  Retirement Application (DOCX) (English, DOCX 37.04 KB)

Open PDF file, 188.11 KB,  Retirement Application (PDF) (English, PDF 188.11 KB)

Contact   for Petition for retired nursing home administrator status

Board of Registration of Nursing Home Administrators

+

Address

250 Washington Street, Boston, MA 02108

Directions 

Phone

Call Board of Registration of Nursing Home Administrators at (800) 414-0168

Call Board of Registration of Nursing Home Administrators at (617) 973-0806

TTY Call Board of Registration of Nursing Home Administrators, TTY at (617) 973-0988

Online

Email Board of Registration of Nursing Home Administrators at Multiboard.Admin@mass.gov

Fax

(617) 973-0980

Related

• 245 CMR 3.00: Licensure