Current Page 1 Page 2 Preview Personal information on this form is collected under section 8 of the Community Care Facilities and Nursing Homes Act, as it relates directly to and is necessary for the application and licensing of a community care facility. If you have any questions about this collection of personal information, you may contact the Community Care Facilities and Nursing Homes Consultant at 902-368-4953. Identification Which type of license are you renewing? - Select -Community Care FacilityNursing HomeDual Facilities Fill in your facility name, address and operator's name in the fields below. Business/Organization Name Contact First Name Contact Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone 1 For example 902-555-5555 Telephone 2 For example 902-555-5555 Fax Number For example 902-555-5555 Email Address