04D2116861 CLIA NUMBER - KINDRED AT HOME KAH DEVELOPMENT 4, LLC

Laboratory Demographics

  • CLIA Code: 04D2116861
  • Facility Name: KINDRED AT HOME KAH DEVELOPMENT 4, LLC
  • Facility Address: 72 WEST 2ND STREET
    WALDRON, AR
    ZIP 72958
  • Facility Phone: 479 637-0914
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: MS. JORDAN L. BROWN
  • NPI Number: 1235589250
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 04D2116861
LAB Type Home Health Agency
Facility Name KINDRED AT HOME KAH DEVELOPMENT 4, LLC
Street 72 WEST 2ND STREET
City WALDRON
State AR
ZIP 72958
Phone 479 637-0914
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 MS. JORDAN L. BROWN

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