04D2116857 CLIA NUMBER - KINDRED AT HOME KAH DEVELOPMENT 4, LLC

Laboratory Demographics

  • CLIA Code: 04D2116857
  • Facility Name: KINDRED AT HOME KAH DEVELOPMENT 4, LLC
  • Facility Address: 1509 EAST MAIN STREET, STE 6
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 479 890-2730
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: LAURA R. GULLETT
  • NPI Number: 1912357948
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 04D2116857
LAB Type Home Health Agency
Facility Name KINDRED AT HOME KAH DEVELOPMENT 4, LLC
Street 1509 EAST MAIN STREET, STE 6
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 890-2730
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2024
Certificate Expiration Date 8/2/2026
Facility Type Home Health Agency
Lab Director LAURA R. GULLETT

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