04D2272918 CLIA NUMBER - PTCOA HOME INFUSION SERVICES LLC

Laboratory Demographics

  • CLIA Code: 04D2272918
  • Facility Name: PTCOA HOME INFUSION SERVICES LLC
  • Facility Address: 108 N SHACKLEFORD ROAD SUITE 104
    LITTLE ROCK, AR
    ZIP 72211
  • Facility Phone: 501 712-2257
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: TERESA JOHNSON
  • NPI Number: 1235723313
  • Taxonomy: 251F00000X - Home Infusion

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CLIA Record

Field Name Field Value
CLIA Number 04D2272918
LAB Type Home Health Agency
Facility Name PTCOA HOME INFUSION SERVICES LLC
Street 108 N SHACKLEFORD ROAD SUITE 104
City LITTLE ROCK
State AR
ZIP 72211
Phone 501 712-2257
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2024
Certificate Expiration Date 12/1/2026
Facility Type Home Health Agency
Lab Director TERESA JOHNSON

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