04D0049600 CLIA NUMBER - RIVENDELL BEHAVIORAL SERVICES OF ARKANSAS UHS OF BENTON LLC

Laboratory Demographics

  • CLIA Code: 04D0049600
  • Facility Name: RIVENDELL BEHAVIORAL SERVICES OF ARKANSAS UHS OF BENTON LLC
  • Facility Address: 100 RIVENDELL DRIVE ATTN JESSICA ROUSE CNO
    BENTON, AR
    ZIP 72015
  • Facility Phone: 501 316-1255
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: JESSICA ROUSE
  • NPI Number: 1568782894
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 04D0049600
LAB Type Hospital
Facility Name RIVENDELL BEHAVIORAL SERVICES OF ARKANSAS UHS OF BENTON LLC
Street 100 RIVENDELL DRIVE ATTN JESSICA ROUSE CNO
City BENTON
State AR
ZIP 72015
Phone 501 316-1255
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Hospital
Lab Director JESSICA ROUSE

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