Section 144-126-2.B - Application Procedure2.B.1. Filing of ApplicationAny person, partnership, association or corporation desiring a license to engage in ESRD services shall, prior to the commencement of such operation, file an application with the Department. Applications submitted on behalf of a corporation or association shall be made by any two (2) officers thereof or by its administrator. All applicants shall comply with the rules and regulations adopted pursuant to Title 22 M.R.S.A., c. 412., § 2041 and § 2042. The applicant shall comply with all other applicable Maine Statutes and rules and regulations.
2.B.2. Contents of Application Each application shall contain:
a. The name by which the ESRD Facility is to be legally known and the name under which it shall be doing business;b. A description of all facilities utilized by the ESRD Facility. This will include the address(es), telephone number(s) and name of owner(s) of all buildings utilized by the ESRD Facility;c. A listing of ESRD services provided by the ESRD Facility;d. For proprietary corporations: the full name and address of each person, firm or corporation having (directly or indirectly) an ownership interest of 5% or more in the facility;e. For business entities with one owner or business partnerships: the full name and address of the owner or each partner;f. For not-for-profit organizations: the full name and address of the President of the Board of Directors or appropriate municipal government representative;g. The name, home address, home telephone number and office telephone numbers of the individual designated by the applicant as the administrator of the ESRD Facility;h. The name of the Director of Nursing;i. The number of full-time equivalent staff.10-144 C.M.R. ch. 126, § 2.B