02D0680417 CLIA NUMBER - POCAHONTAS HEALTHCARE RANDOLPH SNF OP LLC

Laboratory Demographics

  • CLIA Code: 02D0680417
  • Facility Name: POCAHONTAS HEALTHCARE RANDOLPH SNF OP LLC
  • Facility Address: 105 COUNTRY CLUB ROAD
    POCAHONTAS, AR
    ZIP 72455
  • Facility Phone: 870 892-2523
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JEANNIE FORT
  • NPI Number: 1780672360
  • Taxonomy: 314000000X - Skilled Nursing Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 02D0680417
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name POCAHONTAS HEALTHCARE RANDOLPH SNF OP LLC
Street 105 COUNTRY CLUB ROAD
City POCAHONTAS
State AR
ZIP 72455
Phone 870 892-2523
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2025
Certificate Expiration Date 6/16/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JEANNIE FORT

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025