CLIA lab
CLIA 04D0675785: Lake Forest Senior Living, Mountain Home
Mountain Home, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D0675785 belongs to Lake Forest Senior Living, Mountain Home in Mountain Home, AR.
Certificate of Waiver, effective September 1, 2026, expires August 31, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- September 1, 2026
- Certificate expiration
- August 31, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- January 21, 1993
- Facility type
- Skilled nursing or nursing facility
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 04D0675785
- Lab name
- Lake Forest Senior Living, Mountain Home
- Address
- 300 Good Samaritan Drive, Mountain Home, AR 72653
- Phone
- (870) 425-2494
- Fax
- (870) 404-2036
Annual test volume the lab reported
- Waived tests
- 1,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Care facility at this address
- Lake Forest Senior Living at Mountain HomeCMS Care Compare ratings for the facility at the same street address
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- Baxter Health Med-Peds ClinicCertificate of Waiver, Community clinic04D2189382
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Questions
What is the CLIA number for Lake Forest Senior Living, Mountain Home in Mountain Home?
04D0675785, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Lake Forest Senior Living, Mountain Home hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D0675785 expire?
The CMS file lists August 31, 2028 as the certificate expiration date; the certificate took effect September 1, 2026.