04D2118685 CLIA NUMBER - GENTIVA ODYSSEY HEALTHCARE OPERATING A, LP

Laboratory Demographics

  • CLIA Code: 04D2118685
  • Facility Name: GENTIVA ODYSSEY HEALTHCARE OPERATING A, LP
  • Facility Address: 3801 W MAIN STREET STE A
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 704 664-2876
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: SELECE Y. BEASLEY
  • NPI Number: 1467802405
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 04D2118685
LAB Type Hospice
Facility Name GENTIVA ODYSSEY HEALTHCARE OPERATING A, LP
Street 3801 W MAIN STREET STE A
City RUSSELLVILLE
State AR
ZIP 72801
Phone 704 664-2876
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/13/2024
Certificate Expiration Date 9/12/2026
Facility Type Hospice
Lab Director SELECE Y. BEASLEY

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