How To Report a Change of Facility or Address
A licensee shall inform the NHAP of the licensee's current home address, mailing address, and if employed by a nursing facility, the name and address of that employer. A licensee shall report a change in any of this information to the program within 30 calendar days. Failure of the licensee to provide timely notice to the program may result in disciplinary action. A licensee shall provide to the program an address to be included in the public files. These requirements are pursuant to Health and Safety Code 1416.34(h) and 1416.60.
These changes are reported by updating the appropriate sections on the NHA/Facility Profile Sheet (CDPH 514) (PDF)ā and submitting them to the NHAP via:
- E-mail to NHAP@cdph.ca.gov, or
- Fax to (916) 636-6108, or
- Mail to:
Nursing Home Administrator Program
P.O. Box 997416, MS 3302
Sacramento, CA 95899-7416
How To Report A Name Change
If a licensee needs to report a change of legal name to NHAP, the method to do so will depend on whether they need a duplicate license printed or not.
To report a name change and request a new license, the licensee must submit:
- The Declaration and Request for Replacement License form (CDPH 510)āā (PDF).
- Appropriate documentation verifying the change (e.g. copy of drivers' license, marriage certificate, passports, etc.)
- The current duplicate license fee.
If a licensee needs to report a change of legal name without a duplicate license, the licensee must submit:
- The NHA/Facility Profile Sheet form (CDPH 514) (PDF).
- Appropriate documentation verifying the change (e.g. copy of drivers' license, marriage certificate, passports, etc.)
All forms and fees are located on the NHAP website.
Please allow up to 30 days processing time for all program change requests. ā