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.

Medicare Enrollment

1. Send the following to MDH at the address below or submit via email:
   Provide written notice on facility letterhead and include the following:
   1. Health Facility Identification Number (HFID).
   2. CMS Certification Number (CCN).
   3. Previous DBA name.
   4. New DBA name.
   5. Date of change.
   6. Notice signed by authorized official.
2. 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
health.HRD-FedLCR@state.mn.us