04D2171476 CLIA NUMBER - EAGLECREST RECOVERY LLC

Laboratory Demographics

  • CLIA Code: 04D2171476
  • Facility Name: EAGLECREST RECOVERY LLC
  • Facility Address: 1101 SW COVENTRY BLVD
    BENTONVILLE, AR
    ZIP 72712
  • Facility Phone: 949 813-5161
  • Facility Type: Other - DRUG AND ALCOHOL DETOX
  • Facility Type: Waiver
  • Lab Director: DR. JACOB BOYDSTUN
  • NPI Number: 1306484860
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2171476
LAB Type Other - DRUG AND ALCOHOL DETOX
Facility Name EAGLECREST RECOVERY LLC
Street 1101 SW COVENTRY BLVD
City BENTONVILLE
State AR
ZIP 72712
Phone 949 813-5161
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/3/2025
Certificate Expiration Date 9/2/2027
Facility Type Other - DRUG AND ALCOHOL DETOX
Lab Director DR. JACOB BOYDSTUN

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