04D2018784 CLIA NUMBER - CHI ST VINCENT HEALTH AT HOME

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Laboratory Demographics

CLIA Number: 04D2018784

Facility Name: CHI ST VINCENT HEALTH AT HOME

Facility Address:
4 HOSPITAL DRIVE, SUITE 205
MORRILTON, AR
ZIP 72110
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Facility Phone Number: 501 654-6262

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1891778049

Taxonomy: 282NC0060X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	04D2018784
LAB Type	Home Health Agency
Facility Name	CHI ST VINCENT HEALTH AT HOME
Street	4 HOSPITAL DRIVE, SUITE 205
City	MORRILTON
State	AR
ZIP	72110
Phone	501 654-6262
CertificateType	4
CertificateEffectiveDate	1/14/2023
CertificateExpirationDate	1/13/2025
FacilityType	Waiver

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