End-Stage Renal Dialysis Facility Change of Administrator

This page contains instructions for submitting a change of an administrator for an end-stage renal dialysis facility in Minnesota.

Provide written notice on facility letterhead and include the following:

1. Health Facility Identification Number (HFID).
2. CMS Certification Number (CCN).
3. Name and address of facility.
4. Change that has occurred.
5. Date of change.
6. Letter signed by authorized official.

Mail or email letter to:

Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
P.O. Box 64900
St. Paul, Minnesota 55164-0900
Attn: Certification Specialist
health.HRD-FedLCR@state.mn.us