Contact for Request an address change, name change, or duplicate license for nursing home administrators
Board of Registration of Nursing Home Administrators
Phone
The Details of Request an address change, name change, or duplicate license for nursing home administrators
What you need for Request an address change, name change, or duplicate license for nursing home administrators
If you are requesting changes online:
- You will need your Online Licensing username and password
- If you do not have an account yet, you may search for your records with your date of birth and SSN
- You cannot request a name change through the online portal. This must be done via mail.
If you are requesting changes through paper application, you need your:
- License number
- Social Security Number
- Date of birth
For a name change
You must return the original hard copy of your license and submit a copy of supporting documents. Supporting documents include:
- Marriage certificate
- Divorce decree
- Court documents
- Other documentation
Fees for Request an address change, name change, or duplicate license for nursing home administrators
For duplicate licenses:
- You must pay the duplicate license fee for each license you wish to have duplicated
There are no fees for:
- Address changes
- Name changes with renewal
Pay by check or money order, payable to the Commonwealth of Massachusetts.
Don't send cash or electronic funds transfers.
| Name | Fee | Unit |
|---|---|---|
| Name change with new license | $27 | per license |
| Duplicate license | $17 | per license |
How to request Request an address change, name change, or duplicate license for nursing home administrators
- Download and complete the application, found below
- Attach all documentation and fees
- Mail to:
Board of Registration of Nursing Home Administrators
250 Washington Street
Boston, MA 02108
Please note: name changes must be submitted via mail with applicable attachments
For requesting address changes and/or duplicate licenses, you can login to our Online Licensing portal.
More info for Request an address change, name change, or duplicate license for nursing home administrators
- If you are requesting a name change and you have a current or expired license with another board within the Bureau, the requested name change will be effective for all boards
- All addresses are subject to disclosure on request (MGL c. 4, s. 7)
Downloads for Request an address change, name change, or duplicate license for nursing home administrators
Contact for Request an address change, name change, or duplicate license for nursing home administrators
Address
250 Washington Street, Boston, MA 02108
Phone
Fax
(617) 973-0980