04D2294418 CLIA NUMBER - ADVANCED HEALTH AND WELLNESS I

Laboratory Demographics

CLIA Number: 04D2294418

Facility Name: ADVANCED HEALTH AND WELLNESS I

Facility Address:
3729 N CROSSOVER RD #107
FAYETTEVILLE, AR
ZIP 72703
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Facility Phone Number: 479 751-7417

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1326228370

Taxonomy: 261QA1903X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	11/27/2023
CertificateExpirationDate	11/26/2025
FacilityType	Waiver

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