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End-Stage Renal Dialysis Facility Doing Business as (DBA) Name Change
This page contains instructions for submitting a DBA name change of an end-stage renal dialysis facility in Minnesota.
- Send the following to MDH at the address below or submit via email:
Provide written notice on facility letterhead and include the following:
- Health Facility Identification Number (HFID).
- CMS Certification Number (CCN).
- Previous DBA name.
- New DBA name.
- Date of change.
- Notice signed by authorized official.
- Contact the Minnesota Secretary of State and file a Certificate of Assumed Name.
Mail or email completed documents to:
Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
P.O. Box 64900
St. Paul, Minnesota 55164-0900
Attn: Certification Specialist