04D0697001 CLIA NUMBER - CRESTPARK MARIANNA, LLC

Laboratory Demographics

  • CLIA Code: 04D0697001
  • Facility Name: CRESTPARK MARIANNA, LLC
  • Facility Address: 700 WEST CHESNUT
    MARIANNA, AR
    ZIP 72360
  • Facility Phone: 870 295-3466
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DR. SUSAN BALKE
  • NPI Number: 1659526762
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0697001
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CRESTPARK MARIANNA, LLC
Street 700 WEST CHESNUT
City MARIANNA
State AR
ZIP 72360
Phone 870 295-3466
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 DR. SUSAN BALKE

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