04D0887718 CLIA NUMBER - CRESTPARK RETIREMENT INN

Laboratory Demographics

  • CLIA Code: 04D0887718
  • Facility Name: CRESTPARK RETIREMENT INN
  • Facility Address: 707 WEST 20TH
    STUTTGART, AR
    ZIP 72160
  • Facility Phone: 870 673-1657
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: AMBER GIBBS
  • NPI Number: 1508011206
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0887718
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CRESTPARK RETIREMENT INN
Street 707 WEST 20TH
City STUTTGART
State AR
ZIP 72160
Phone 870 673-1657
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/16/2024
Certificate Expiration Date 6/15/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director AMBER GIBBS

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