04D2116863 CLIA NUMBER - CENTERWELL HOME HEALTH KAH DEVELOPMENT 4, LLC

Laboratory Demographics

  • CLIA Code: 04D2116863
  • Facility Name: CENTERWELL HOME HEALTH KAH DEVELOPMENT 4, LLC
  • Facility Address: 210 N STATE LINE AVENUE, SUITE 501
    TEXARKANA, AR
    ZIP 71854
  • Facility Phone: 870 330-7796
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: JENNIFER A. MAYBERRY
  • NPI Number: 1346692456
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 04D2116863
LAB Type Home Health Agency
Facility Name CENTERWELL HOME HEALTH KAH DEVELOPMENT 4, LLC
Street 210 N STATE LINE AVENUE, SUITE 501
City TEXARKANA
State AR
ZIP 71854
Phone 870 330-7796
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 JENNIFER A. MAYBERRY

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