04D0468704 CLIA NUMBER - PROMENADE HEALTH AND REHAB SRN MANAGEMENT 2, LLC

Laboratory Demographics

  • CLIA Code: 04D0468704
  • Facility Name: PROMENADE HEALTH AND REHAB SRN MANAGEMENT 2, LLC
  • Facility Address: 1101 S PROMENADE BOULEDVARD
    ROGERS, AR
    ZIP 72758
  • Facility Phone: 479 268-3989
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JOHN T. SMILEY
  • NPI Number: 1992185789
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0468704
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PROMENADE HEALTH AND REHAB SRN MANAGEMENT 2, LLC
Street 1101 S PROMENADE BOULEDVARD
City ROGERS
State AR
ZIP 72758
Phone 479 268-3989
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2025
Certificate Expiration Date 3/16/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JOHN T. SMILEY

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