Actuel Page 1 Page 2 Aperçu 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? - Sélectionner -Community Care FacilityNursing HomeDual Facilities Fill in your facility name, address and operator's name in the fields below. Nom de l’entreprise/organisation Prénom de la personne-ressource Nom de la personne-ressource Adresse 1 Adresse 2 Ville, municipalité, communauté Province Code postal Exemple : C1B 0X1 ou 12345 Pays Téléphone 1 Exemple : 902-555-5555 Téléphone 2 Exemple : 902-555-5555 Télécopieur Exemple : 902-555-5555 Adresse courriel