04D1030130 CLIA NUMBER - SOUTHRIDGE VILLAGE NURSING AND REHAB

Laboratory Demographics

  • CLIA Code: 04D1030130
  • Facility Name: SOUTHRIDGE VILLAGE NURSING AND REHAB
  • Facility Address: 400 SOUTHRIDGE PARKWAY
    HEBER SPRINGS, AR
    ZIP 72543
  • Facility Phone: 501 362-3185
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SHANA RODGERS
  • NPI Number: 1982020541
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D1030130
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SOUTHRIDGE VILLAGE NURSING AND REHAB
Street 400 SOUTHRIDGE PARKWAY
City HEBER SPRINGS
State AR
ZIP 72543
Phone 501 362-3185
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director SHANA RODGERS

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