05D2313603 CLIA NUMBER - REVIVE WELLNESS GROUP

Laboratory Demographics

  • CLIA Code: 05D2313603
  • Facility Name: REVIVE WELLNESS GROUP
  • Facility Address: 5401 VANALDEN AVE
    TARZANA, CA
    ZIP 91356
  • Facility Phone: 818 395-7137
  • Facility Type: Other - DRUG AND ALCOHOL TREATMEN
  • Facility Type: Waiver
  • Lab Director: COURTNEY SCOTT
  • NPI Number: 1922868827
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2313603
LAB Type Other - DRUG AND ALCOHOL TREATMEN
Facility Name REVIVE WELLNESS GROUP
Street 5401 VANALDEN AVE
City TARZANA
State CA
ZIP 91356
Phone 818 395-7137
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Other - DRUG AND ALCOHOL TREATMEN
Lab Director COURTNEY SCOTT

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