04D2009219 CLIA NUMBER - SOUTHERN TRACE REHAB-CARE CTR BRYANT SNF OPERATIONS LLC

Laboratory Demographics

  • CLIA Code: 04D2009219
  • Facility Name: SOUTHERN TRACE REHAB-CARE CTR BRYANT SNF OPERATIONS LLC
  • Facility Address: 22515 INTERSTATE 30
    BRYANT, AR
    ZIP 72022
  • Facility Phone: 501 847-0777
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: NANCY BROWN
  • NPI Number: 1114247335
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D2009219
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SOUTHERN TRACE REHAB-CARE CTR BRYANT SNF OPERATIONS LLC
Street 22515 INTERSTATE 30
City BRYANT
State AR
ZIP 72022
Phone 501 847-0777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2024
Certificate Expiration Date 6/28/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director NANCY BROWN

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