04D0679850 CLIA NUMBER - SOUTHFORK RIVER THERAPY & LIVING

Laboratory Demographics

  • CLIA Code: 04D0679850
  • Facility Name: SOUTHFORK RIVER THERAPY & LIVING
  • Facility Address: 624 HWY 62-412 WEST
    SALEM, AR
    ZIP 72576
  • Facility Phone: 870 895-3817
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: GAVIN MOORE
  • NPI Number: 1376531202
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0679850
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SOUTHFORK RIVER THERAPY & LIVING
Street 624 HWY 62-412 WEST
City SALEM
State AR
ZIP 72576
Phone 870 895-3817
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 GAVIN MOORE

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