04D2074939 CLIA NUMBER - CEDAR RIDGE

Laboratory Demographics

CLIA Code: 04D2074939
Facility Name: CEDAR RIDGE
Facility Address: 107 THICKSTEN DRIVE
ALMA, AR
ZIP 72921
Facility Phone: 479 632-2745
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: WALTONA D. WILSON WARD
NPI Number: 1184848202
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	04D2074939
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	CEDAR RIDGE
Street	107 THICKSTEN DRIVE
City	ALMA
State	AR
ZIP	72921
Phone	479 632-2745
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	3/19/2024
Certificate Expiration Date	3/18/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	WALTONA D. WILSON WARD

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