04D0891907 CLIA NUMBER - DERMOTT CITY NURSING HOME

Laboratory Demographics

  • CLIA Code: 04D0891907
  • Facility Name: DERMOTT CITY NURSING HOME
  • Facility Address: 702 WEST GAINES
    DERMOTT, AR
    ZIP 71638
  • Facility Phone: 870 538-3241
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LESLIE J. WILLIAMS
  • NPI Number: 1134286750
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0891907
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name DERMOTT CITY NURSING HOME
Street 702 WEST GAINES
City DERMOTT
State AR
ZIP 71638
Phone 870 538-3241
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2024
Certificate Expiration Date 9/19/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LESLIE J. WILLIAMS

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