04D1047708 CLIA NUMBER - BOST INC - ICF/MR DEPT

Laboratory Demographics

  • CLIA Code: 04D1047708
  • Facility Name: BOST INC - ICF/MR DEPT
  • Facility Address: 7701 SOUTH ZERO
    FORT SMITH, AR
    ZIP 72903
  • Facility Phone: 479 478-5624
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: TINA OSBORNE
  • NPI Number: 1275643355
  • Taxonomy: 101Y00000X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 04D1047708
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name BOST INC - ICF/MR DEPT
Street 7701 SOUTH ZERO
City FORT SMITH
State AR
ZIP 72903
Phone 479 478-5624
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/10/2023
Certificate Expiration Date 11/9/2025
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director TINA OSBORNE

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