04D0887089 CLIA NUMBER - MAPLE HEALTHCARE HAZEN SNF OPERATOR LLC

Laboratory Demographics

  • CLIA Code: 04D0887089
  • Facility Name: MAPLE HEALTHCARE HAZEN SNF OPERATOR LLC
  • Facility Address: 200 S MAPLE STREET
    HAZEN, AR
    ZIP 72064
  • Facility Phone: 870 255-4323
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SHANNON PUTMAN
  • NPI Number: 1679057137
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0887089
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MAPLE HEALTHCARE HAZEN SNF OPERATOR LLC
Street 200 S MAPLE STREET
City HAZEN
State AR
ZIP 72064
Phone 870 255-4323
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director SHANNON PUTMAN

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