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Mississippi State Board of Nursing Home Administrators 1755 Lelia Drive, Suite 305, Jackson, MS 39216Name:(601) 3626914www.MSN.ms.license #:Date:Change of Facility Old Facility Info:Position: ___
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Obtain the change of facility form from the appropriate authority or office.
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Fill out the form completely, providing all required information accurately.
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Who needs change of facility?

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Individuals or businesses who are moving to a new facility or location.
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Change of facility is a process of notifying the appropriate regulatory bodies about any changes in the physical location or usage of a facility.
Any entity or individual who operates a facility that is subject to regulatory requirements must file a change of facility when there are modifications to the facility.
To fill out a change of facility form, you will need to provide information about the current facility, the proposed changes, and any relevant documentation to support the modifications.
The purpose of change of facility is to ensure that regulatory agencies are aware of any alterations to a facility that may impact compliance with regulations or pose potential risks to the environment or public health.
The information required to be reported on a change of facility form typically includes details about the current facility, the proposed modifications, the reasons for the changes, and any potential impacts.
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