Each licensed nursing home administrator, licensed temporary nursing home administrator, and licensed health services executive shall report to the board of executives of long-term services and supports any change in any of the following not later than ten days after the change:

1. (A) The individual's residence mailing address;
2. (B) The name and address of each place at which the individual practices nursing home administration;
3. (C) The name and address of each long-term services and supports setting at which the individual serves in a leadership position or directs the practices of others.