05D2287034 CLIA NUMBER - REVIVE PATHWAY

Laboratory Demographics

  • CLIA Code: 05D2287034
  • Facility Name: REVIVE PATHWAY
  • Facility Address: 1240 BROADWAY
    EL CAJON, CA
    ZIP 92021
  • Facility Phone: 619 841-1310
  • Facility Type: Other - SUBSTANCE USE DISORDER
  • Facility Type: Waiver
  • Lab Director: GREG A. GREENBERG
  • NPI Number: 1962117440
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2287034
LAB Type Other - SUBSTANCE USE DISORDER
Facility Name REVIVE PATHWAY
Street 1240 BROADWAY
City EL CAJON
State CA
ZIP 92021
Phone 619 841-1310
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/8/2025
Certificate Expiration Date 8/7/2027
Facility Type Other - SUBSTANCE USE DISORDER
Lab Director GREG A. GREENBERG

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