04D2011152 CLIA NUMBER - KATHERINE'S PLACE AT WEDINGTON MCNC, INC

Laboratory Demographics

  • CLIA Code: 04D2011152
  • Facility Name: KATHERINE'S PLACE AT WEDINGTON MCNC, INC
  • Facility Address: 4405 W PERSIMMON ST
    FAYETTEVILLE, AR
    ZIP 72704
  • Facility Phone: 479 444-6108
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: KELLY SOUZA
  • NPI Number: 1194044941
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D2011152
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name KATHERINE'S PLACE AT WEDINGTON MCNC, INC
Street 4405 W PERSIMMON ST
City FAYETTEVILLE
State AR
ZIP 72704
Phone 479 444-6108
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2024
Certificate Expiration Date 8/11/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director KELLY SOUZA

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