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Request an address change, name change, or duplicate license - nursing home administrators

If you are a licensed nursing home administrator, you can use these steps to request a name change, address change, and/or a duplicate license.

Board of Registration of Nursing Home Administrators

The Details

What you need

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 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

  1. Download and complete the application, found below
  2. Attach all documentation and fees
  3. Mail to:

Board of Registration of Nursing Home Administrators
239 Causeway St.
Suite 500, 5th Floor
Boston, MA 02114

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

  • 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

Contact

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