04D1027329 CLIA NUMBER - MILLCREEK OF ARKANSAS HABILITATION CENTERS, INC

Laboratory Demographics

  • CLIA Code: 04D1027329
  • Facility Name: MILLCREEK OF ARKANSAS HABILITATION CENTERS, INC
  • Facility Address: 1810 INDUSTRIAL DRIVE
    FORDYCE, AR
    ZIP 71742
  • Facility Phone: 870 352-8203
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: AMANDA WILLIAMS
  • NPI Number: 1659135358
  • Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities

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CLIA Record

Field Name Field Value
CLIA Number 04D1027329
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name MILLCREEK OF ARKANSAS HABILITATION CENTERS, INC
Street 1810 INDUSTRIAL DRIVE
City FORDYCE
State AR
ZIP 71742
Phone 870 352-8203
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2024
Certificate Expiration Date 6/27/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director AMANDA WILLIAMS

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