04D1073713 CLIA NUMBER - WILLOW GROVE OF MAUMELLE EC OPCO MAUMELLE, LLC

Laboratory Demographics

  • CLIA Code: 04D1073713
  • Facility Name: WILLOW GROVE OF MAUMELLE EC OPCO MAUMELLE, LLC
  • Facility Address: 100 BRINGLER DRIVE
    MAUMELLE, AR
    ZIP 72113
  • Facility Phone: 501 851-0400
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: LACEY GREEN
  • NPI Number: 1033547443
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D1073713
LAB Type Assisted Living Facility
Facility Name WILLOW GROVE OF MAUMELLE EC OPCO MAUMELLE, LLC
Street 100 BRINGLER DRIVE
City MAUMELLE
State AR
ZIP 72113
Phone 501 851-0400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/14/2025
Certificate Expiration Date 9/13/2027
Facility Type Assisted Living Facility
Lab Director LACEY GREEN

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