04D2188926 CLIA NUMBER - EAGLECREST RECOVERY LLC

Laboratory Demographics

  • CLIA Code: 04D2188926
  • Facility Name: EAGLECREST RECOVERY LLC
  • Facility Address: 308 N 24TH STREET
    ROGERS, AR
    ZIP 72756
  • Facility Phone: 949 813-5161
  • Facility Type: Other - DRUG AND ALCOHOL DETOX
  • Facility Type: Waiver
  • Lab Director: DR. JACOB BOYDSTON
  • NPI Number: 1336817949
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D2188926
LAB Type Other - DRUG AND ALCOHOL DETOX
Facility Name EAGLECREST RECOVERY LLC
Street 308 N 24TH STREET
City ROGERS
State AR
ZIP 72756
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 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Other - DRUG AND ALCOHOL DETOX
Lab Director DR. JACOB BOYDSTON

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