04D1079751 CLIA NUMBER - CHANGE CENTER FOR HEALTH

Laboratory Demographics

  • CLIA Code: 04D1079751
  • Facility Name: CHANGE CENTER FOR HEALTH
  • Facility Address: 425 W CAPITOL AVE, SUITE 210
    LITTLE ROCK, AR
    ZIP 72201
  • Facility Phone: 501 324-2643
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DEBRA S. VELEZ
  • NPI Number: 1720390362
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 04D1079751
LAB Type Practitioner Other
Facility Name CHANGE CENTER FOR HEALTH
Street 425 W CAPITOL AVE, SUITE 210
City LITTLE ROCK
State AR
ZIP 72201
Phone 501 324-2643
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2024
Certificate Expiration Date 2/5/2026
Facility Type Practitioner Other
Lab Director DEBRA S. VELEZ

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This page was last updated on: 3/20/2025