04D2178010 CLIA NUMBER - HIRAM SHADDOX HEALTH AND REHAB MHPNC, INC

Laboratory Demographics

  • CLIA Code: 04D2178010
  • Facility Name: HIRAM SHADDOX HEALTH AND REHAB MHPNC, INC
  • Facility Address: 1100 PINE TREE LANE
    MOUNTAIN HOME, AR
    ZIP 72653
  • Facility Phone: 870 232-0320
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TIFFANY LOCKARD
  • NPI Number: 1225454325
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D2178010
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name HIRAM SHADDOX HEALTH AND REHAB MHPNC, INC
Street 1100 PINE TREE LANE
City MOUNTAIN HOME
State AR
ZIP 72653
Phone 870 232-0320
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2024
Certificate Expiration Date 1/22/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director TIFFANY LOCKARD

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