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04D2093855 CLIA NUMBER - TRINITY RIVER VALLEY HOME HEALTH LLC

Laboratory Demographics

CLIA Number: 04D2093855

Facility Name: TRINITY RIVER VALLEY HOME HEALTH LLC

Facility Address:
1708 WEST C PLACE
RUSSELLVILLE, AR
ZIP 72801
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Facility Phone Number: 479 662-4040

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1972945319

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 04D2093855
LAB Type Home Health Agency
Facility Name TRINITY RIVER VALLEY HOME HEALTH LLC
Street 1708 WEST C PLACE
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 662-4040
CertificateType 4
CertificateEffectiveDate 4/6/2023
CertificateExpirationDate 4/5/2025
FacilityType Waiver

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