04D0920989 CLIA NUMBER - CRESTPARK DEWITT LLC

Laboratory Demographics

  • CLIA Code: 04D0920989
  • Facility Name: CRESTPARK DEWITT LLC
  • Facility Address: 1325 LIBERTY DRIVE
    DE WITT, AR
    ZIP 72042
  • Facility Phone: 870 946-3569
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: CATHY DONDANVILLE
  • NPI Number: 1528213642
  • Taxonomy: 314000000X - Skilled Nursing Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D0920989
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CRESTPARK DEWITT LLC
Street 1325 LIBERTY DRIVE
City DE WITT
State AR
ZIP 72042
Phone 870 946-3569
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2024
Certificate Expiration Date 10/15/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director CATHY DONDANVILLE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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