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04D2140158 CLIA NUMBER - CARE IV HOME HEALTH CARE IV INC

Laboratory Demographics

CLIA Number: 04D2140158

Facility Name: CARE IV HOME HEALTH CARE IV INC

Facility Address:
438 E MILLSAP ROAD STE 204
FAYETTEVILLE, AR
ZIP 72703
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Facility Phone Number: 479 750-1155

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1336159318

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 04D2140158
LAB Type Home Health Agency
Facility Name CARE IV HOME HEALTH CARE IV INC
Street 438 E MILLSAP ROAD STE 204
City FAYETTEVILLE
State AR
ZIP 72703
Phone 479 750-1155
CertificateType 4
CertificateEffectiveDate 11/15/2023
CertificateExpirationDate 11/14/2025
FacilityType Waiver

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