04D1107609 CLIA NUMBER - HOME BOUND MEDICAL

Laboratory Demographics

  • CLIA Code: 04D1107609
  • Facility Name: HOME BOUND MEDICAL
  • Facility Address: 358 HWY 5 NORTH
    MOUNTAIN HOME, AR
    ZIP 72653
  • Facility Phone: 870 425-2446
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: GAYLA D. GRAY
  • NPI Number: 1790054153
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 04D1107609
LAB Type Home Health Agency
Facility Name HOME BOUND MEDICAL
Street 358 HWY 5 NORTH
City MOUNTAIN HOME
State AR
ZIP 72653
Phone 870 425-2446
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Home Health Agency
Lab Director GAYLA D. GRAY

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