04D2071983 CLIA NUMBER - EVERGREEN LIVING CENTER AT STAGECOACH

Laboratory Demographics

  • CLIA Code: 04D2071983
  • Facility Name: EVERGREEN LIVING CENTER AT STAGECOACH
  • Facility Address: 6907 HWY 5 NORTH
    BRYANT, AR
    ZIP 72022
  • Facility Phone: 501 213-0547
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: AMANDA J. ROECK
  • NPI Number: 1962851568
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D2071983
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name EVERGREEN LIVING CENTER AT STAGECOACH
Street 6907 HWY 5 NORTH
City BRYANT
State AR
ZIP 72022
Phone 501 213-0547
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/22/2024
Certificate Expiration Date 1/21/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director AMANDA J. ROECK

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