04D2046032 CLIA NUMBER - METHODIST RESIDENTIAL TREATMENT CENTER

Laboratory Demographics

CLIA Code: 04D2046032
Facility Name: METHODIST RESIDENTIAL TREATMENT CENTER
Facility Address: 211 CHURCH STREET
BONO, AR
ZIP 72416
Facility Phone: 870 932-8880
Facility Type: Other - PSYCHIATRIC RESIDENTIAL
Facility Type: Waiver
Lab Director: MR. CRAIG C. GAMMON
NPI Number: 1851546725
Taxonomy: 322D00000X - Residential Treatment Facility, Emotionally Disturbed Children

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CLIA Record

Field Name	Field Value
CLIA Number	04D2046032
LAB Type	Other - PSYCHIATRIC RESIDENTIAL
Facility Name	METHODIST RESIDENTIAL TREATMENT CENTER
Street	211 CHURCH STREET
City	BONO
State	AR
ZIP	72416
Phone	870 932-8880
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	8/24/2024
Certificate Expiration Date	8/23/2026
Facility Type	Other - PSYCHIATRIC RESIDENTIAL
Lab Director	MR. CRAIG C. GAMMON

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