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

Laboratory Demographics

CLIA Number: 04D2009219

Facility Name: SOUTHERN TRACE REHAB-CARE CTR BRYANT SNF OPERATIONS LLC

Facility Address:
22515 INTERSTATE 30
BRYANT, AR
ZIP 72022
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Facility Phone Number: 501 847-0777

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver
NPI Number: 1114247335

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

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
CertificateType 4
CertificateEffectiveDate 6/29/2022
CertificateExpirationDate 6/28/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024