Name Change

Providers licensed by Health Standards Section (HSS) must notify the department of any name change for the ASC. Providers shall pay the $25.00 application fee for a change in license, a completed license renewal application to reflect the new name, notification and name change with the Secretary of State, and a revised 855 reflecting the name change. Notification shall be in writing, on facility or agency letterhead.

Please contact the Program Desk at 225.342.9348 for additional information or e-mail: