04D0919791 CLIA NUMBER - DELTA HOUSE, INC THE ICF/MR

Laboratory Demographics

  • CLIA Code: 04D0919791
  • Facility Name: DELTA HOUSE, INC THE ICF/MR
  • Facility Address: 252 DESOTO STREET
    WEST HELENA, AR
    ZIP 72390
  • Facility Phone: 870 572-4124
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: CONSTANCE R. JARRETT, RN
  • NPI Number: 1538373931
  • Taxonomy: 310500000X - Intermediate Care Facility, Mental Illness

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CLIA Record

Field Name Field Value
CLIA Number 04D0919791
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name DELTA HOUSE, INC THE ICF/MR
Street 252 DESOTO STREET
City WEST HELENA
State AR
ZIP 72390
Phone 870 572-4124
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director CONSTANCE R. JARRETT, RN

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