05D2107619 CLIA NUMBER - MOUNT ST. JOSEPH- ST. ELIZABETH DBA EPIPHANY CENTER

Laboratory Demographics

CLIA Code: 05D2107619
Facility Name: MOUNT ST. JOSEPH- ST. ELIZABETH DBA EPIPHANY CENTER
Facility Address: 100 MASONIC AVE EPIPHANY CLINIC
SAN FRANCISCO, CA
ZIP 94118
Facility Phone: 415 351-4048
Facility Type: Other - RESIDENTIAL RECOVERY SETT
Facility Type: Waiver
Lab Director: CLEMENT DONAHUE, MD
NPI Number: 1003010695
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	05D2107619
LAB Type	Other - RESIDENTIAL RECOVERY SETT
Facility Name	MOUNT ST. JOSEPH- ST. ELIZABETH DBA EPIPHANY CENTER
Street	100 MASONIC AVE EPIPHANY CLINIC
City	SAN FRANCISCO
State	CA
ZIP	94118
Phone	415 351-4048
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	1/19/2024
Certificate Expiration Date	1/18/2026
Facility Type	Other - RESIDENTIAL RECOVERY SETT
Lab Director	CLEMENT DONAHUE, MD

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