04D0718959 CLIA NUMBER - CRESTPARK WYNNE LLC

Laboratory Demographics

  • CLIA Code: 04D0718959
  • Facility Name: CRESTPARK WYNNE LLC
  • Facility Address: PO BOX 1127
    WYNNE, AR
    ZIP 72396
  • Facility Phone: 870 238-7941
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: KIM DOLLAR
  • NPI Number: 1518112630
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0718959
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CRESTPARK WYNNE LLC
Street PO BOX 1127
City WYNNE
State AR
ZIP 72396
Phone 870 238-7941
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 KIM DOLLAR

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