04D0677775 CLIA NUMBER - STELLA MANOR NURSING CENTER

Laboratory Demographics

  • CLIA Code: 04D0677775
  • Facility Name: STELLA MANOR NURSING CENTER
  • Facility Address: 400 N VANCOUVER
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 479 968-4141
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: HEATHER SHOCKEY
  • NPI Number: 1144294489
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0677775
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name STELLA MANOR NURSING CENTER
Street 400 N VANCOUVER
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 968-4141
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 Skilled Nursing Facility/Nursing Facility
Lab Director HEATHER SHOCKEY

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