04D0883592 CLIA NUMBER - MONTGOMERY COUNTY NURSING HOME

Laboratory Demographics

  • CLIA Code: 04D0883592
  • Facility Name: MONTGOMERY COUNTY NURSING HOME
  • Facility Address: 741 SOUTH DRIVE
    MOUNT IDA, AR
    ZIP 71957
  • Facility Phone: 870 867-2156
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TAMMY ELDER
  • NPI Number: 1487667655
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0883592
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MONTGOMERY COUNTY NURSING HOME
Street 741 SOUTH DRIVE
City MOUNT IDA
State AR
ZIP 71957
Phone 870 867-2156
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2024
Certificate Expiration Date 3/10/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director TAMMY ELDER

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