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Register as a temporary nursing service agency

Apply for initial registration for a temporary nursing service agency (nursing pool), or register a change of ownership.
If your application is complete and acceptable, including payment as required, the Department of Public Health will assign a registration number effective the date of receipt of your application.

Contacts

Division of Health Care Facility Licensure and Certification

Phone

Call Division of Health Care Facility Licensure and Certification at (617) 753-8000

The Details   of Register as a temporary nursing service agency

What you need   for Register as a temporary nursing service agency

Registration information

  • Temporary Nursing Service Agency Name (name by which you will do business)
  • Applicant Name (Individual Owner, Partnership, Limited Partnership, Corporation Name)
  • Address From Which Agency Will Do Business in Massachusetts (Street, City/Town, ZIP)
  • Telephone Number
  • Fax Number
  • Administrator’s Name
  • Owner’s Name(s) (All individuals with a 5% more ownership interest)

If applicable

  • If you are registering a change of ownership, you must attach a copy of the bill of sale or other documentation of the change of ownership
  • If you will be operating at more than one location, you must complete a separate registration application for each additional location
  • If the owner is a partnership, limited partnership, or corporation of any nature, please provide the nine digit identification number as registered with the Massachusetts Secretary of State’s office

Fees   for Register as a temporary nursing service agency

Please submit one check for all registration fees, and make it payable to "Commonwealth of Massachusetts."

Name Fee Unit
Registration fee $750 each
Additional location registration fee $300 each
Change of Ownership fee $250 each
Change of Ownership additional location fee $100 each
Change of Location fee $100 each

How to register   Register as a temporary nursing service agency

  1. Download and complete the Application for Initial Registration (DOCX)
  2. 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

Contact   for Register as a temporary nursing service agency

Address
67 Forest St., Marlborough, MA 01752
Directions 
Phone
Call Division of Health Care Facility Licensure and Certification at (617) 753-8000

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