04D2294418 CLIA NUMBER - ADVANCED HEALTH AND WELLNESS I

Laboratory Demographics

  • CLIA Code: 04D2294418
  • Facility Name: ADVANCED HEALTH AND WELLNESS I
  • Facility Address: 3729 N CROSSOVER RD #107
    FAYETTEVILLE, AR
    ZIP 72703
  • Facility Phone: 479 751-7417
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DIANA J. HOLTE
  • NPI Number: 1326228370
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2294418
LAB Type Federally Qualified Health Center
Facility Name ADVANCED HEALTH AND WELLNESS I
Street 3729 N CROSSOVER RD #107
City FAYETTEVILLE
State AR
ZIP 72703
Phone 479 751-7417
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/27/2023
Certificate Expiration Date 11/26/2025
Facility Type Federally Qualified Health Center
Lab Director DIANA J. HOLTE

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