CLIA lab
CLIA 04D1059020: Southeast Rehabilitation Hospital
Lake Village, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D1059020 belongs to Southeast Rehabilitation Hospital in Lake Village, AR.
Certificate of Waiver, effective September 20, 2026, expires September 19, 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
Run it in Rivvi
Map your lab's test names to LOINC codes
Open in RivviFree to start. Opens Rivvi, the AI workspace for healthcare teams.
Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- September 20, 2026
- Certificate expiration
- September 19, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- September 20, 2006
- Facility type
- Hospital
- 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
- 04D1059020
- Lab name
- Southeast Rehabilitation Hospital
- Address
- 905 Borgognoni Dr, Lake Village, AR 71653
- Phone
- (870) 265-4333
- Fax
- (870) 265-4334
Annual test volume the lab reported
- Waived tests
- 10,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Lake Village, AR
- Chicot Memorial Medical CenterCertificate of Compliance, Hospital04D0465387
- Chicot Memorial Medical Center Home HealthCertificate of Waiver, Home health agency04D0681352
- Hunter's Pharmacy, IncCertificate of Waiver, Pharmacy04D1095104
- Lake Village ClinicCertificate of Waiver, Physician office04D0693694
- Lake Village Rehab-Care CTRCertificate of Waiver, Skilled nursing or nursing facility04D2009218
- Lake Village School Based ClinicCertificate of Waiver, School or student health service04D2126174
- Lakeside High School Based ClinicCertificate of Waiver, School or student health service04D2142136
- Pathway Recovery DevelopmentCertificate of Waiver, Comprehensive outpatient rehab facility04D2312252
- Southeast Rural Health ClinicCertificate of Waiver, Rural health clinic04D2183693
Related
Questions
What is the CLIA number for Southeast Rehabilitation Hospital in Lake Village?
04D1059020, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Southeast Rehabilitation Hospital hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D1059020 expire?
The CMS file lists September 19, 2028 as the certificate expiration date; the certificate took effect September 20, 2026.