04D2293241 CLIA NUMBER - VILLAGE PARK OF CONWAY, INC

Laboratory Demographics

CLIA Number: 04D2293241

Facility Name: VILLAGE PARK OF CONWAY, INC

Facility Address:
1622 SCOTT STREET
CONWAY, AR
ZIP 72034
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Facility Phone Number: 501 327-6428

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1225365190

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	04D2293241
LAB Type	Assisted Living Facility
Facility Name	VILLAGE PARK OF CONWAY, INC
Street	1622 SCOTT STREET
City	CONWAY
State	AR
ZIP	72034
Phone	501 327-6428
CertificateType	4
CertificateEffectiveDate	11/6/2023
CertificateExpirationDate	11/5/2025
FacilityType	Waiver

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