Rural Health Clinic Legal Entity Name Change Packet

The information and forms in this packet are designed to assist providers in completing information to change the "legal entity" name of the Rural Health Clinic. This should be identical to the legal name reported with the IRS. Please DON'T use this packet if you are only changing the DBA (doing business as) name of the RHC. Please send this packet to the Louisiana Department of Health, Health Standards Section, P.O. Box 3767, Baton Rouge, LA 70821. Please send all payments associated with this packet to LDH-Licensing, P.O. Box 62949, New Orleans, LA 70162-2949.

If the legal entity name change occurs in an RHC that is licensed as an offsite campus of a hospital you will also need to submit a Hospital Legal Entity Name Change Packet to the Hospital Program Manager assigned to your hospital.