05D2291652 CLIA NUMBER - REVOLVE RECOVERY, INC

Laboratory Demographics

  • CLIA Code: 05D2291652
  • Facility Name: REVOLVE RECOVERY, INC
  • Facility Address: 3101 WASHINGTON BLVD
    MARINA DEL REY, CA
    ZIP 90292
  • Facility Phone: 800 957-1129
  • Facility Type: Other - DAY-PATIENT MENTAL HEALTH
  • Facility Type: Waiver
  • Lab Director: STACY A. COHEN
  • NPI Number: 1548997539
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2291652
LAB Type Other - DAY-PATIENT MENTAL HEALTH
Facility Name REVOLVE RECOVERY, INC
Street 3101 WASHINGTON BLVD
City MARINA DEL REY
State CA
ZIP 90292
Phone 800 957-1129
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/13/2025
Certificate Expiration Date 10/12/2027
Facility Type Other - DAY-PATIENT MENTAL HEALTH
Lab Director STACY A. COHEN

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