04D1064024 CLIA NUMBER - HERITAGE SQUARE HEALTHCARE CENTER

Laboratory Demographics

  • CLIA Code: 04D1064024
  • Facility Name: HERITAGE SQUARE HEALTHCARE CENTER
  • Facility Address: 710 NORTH RUDDLE ROAD
    BLYTHEVILLE, AR
    ZIP 72315
  • Facility Phone: 870 763-3654
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: PHILANDER SMITH
  • NPI Number: 1205319340
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D1064024
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name HERITAGE SQUARE HEALTHCARE CENTER
Street 710 NORTH RUDDLE ROAD
City BLYTHEVILLE
State AR
ZIP 72315
Phone 870 763-3654
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2025
Certificate Expiration Date 1/25/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director PHILANDER SMITH

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