04D0684294 CLIA NUMBER - EASTERSEALS ARKANSAS

Laboratory Demographics

  • CLIA Code: 04D0684294
  • Facility Name: EASTERSEALS ARKANSAS
  • Facility Address: 11805 FAIRVIEW RD
    LITTLE ROCK, AR
    ZIP 72212
  • Facility Phone: 501 221-8431
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: DR. BARRY FORD
  • NPI Number: 1457010340
  • Taxonomy: 103K00000X - Behavior Analyst

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CLIA Record

Field Name Field Value
CLIA Number 04D0684294
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name EASTERSEALS ARKANSAS
Street 11805 FAIRVIEW RD
City LITTLE ROCK
State AR
ZIP 72212
Phone 501 221-8431
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 Intermediate Care Facility for Mentally Retarded
Lab Director DR. BARRY FORD

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