04D2170357 CLIA NUMBER - BHG LI, LLC BHG NORTH LITTLE ROCK TREATMENT CENTER

Laboratory Demographics

CLIA Number: 04D2170357

Facility Name: BHG LI, LLC BHG NORTH LITTLE ROCK TREATMENT CENTER

Facility Address:
4260 STOCKTON DR, STE B
NORTH LITTLE ROCK, AR
ZIP 72117
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Facility Phone Number: 501 319-7963

Facility Type: Other - OPIOD TREATMENT PROGRAM

Certificate Type: Waiver

NPI Number: 1083260822

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2170357
LAB Type	Other - OPIOD TREATMENT PROGRAM
Facility Name	BHG LI, LLC BHG NORTH LITTLE ROCK TREATMENT CENTER
Street	4260 STOCKTON DR, STE B
City	NORTH LITTLE ROCK
State	AR
ZIP	72117
Phone	501 319-7963
CertificateType	4
CertificateEffectiveDate	8/8/2023
CertificateExpirationDate	8/7/2025
FacilityType	Waiver

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