04D2053747 CLIA NUMBER - PEDIATRIC COMPLEX CARE OF ARKANSAS

Laboratory Demographics

  • CLIA Code: 04D2053747
  • Facility Name: PEDIATRIC COMPLEX CARE OF ARKANSAS
  • Facility Address: 4100 HERITAGE DRIVE
    NORTH LITTLE ROCK, AR
    ZIP 72117
  • Facility Phone: 501 945-3177
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: LAURA A. SINK
  • NPI Number: 1336271659
  • Taxonomy: 235Z00000X - Speech-Language Pathologist

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CLIA Record

Field Name Field Value
CLIA Number 04D2053747
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name PEDIATRIC COMPLEX CARE OF ARKANSAS
Street 4100 HERITAGE DRIVE
City NORTH LITTLE ROCK
State AR
ZIP 72117
Phone 501 945-3177
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director LAURA A. SINK

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