11D2291771 CLIA NUMBER - REVELARE RECOVERY, LLC

Laboratory Demographics

CLIA Number: 11D2291771

Facility Name: REVELARE RECOVERY, LLC

Facility Address:
750 GLENWOOD AVENUE, SE, BLDG 200, SUITE 210
ATLANTA, GA
ZIP 30316
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Facility Phone Number: 678 920-9431

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1629853189

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name	Field Value
CLIA Number	11D2291771
LAB Type	Independent
Facility Name	REVELARE RECOVERY, LLC
Street	750 GLENWOOD AVENUE, SE, BLDG 200, SUITE 210
City	ATLANTA
State	GA
ZIP	30316
Phone	678 920-9431
CertificateType	4
CertificateEffectiveDate	10/16/2023
CertificateExpirationDate	10/15/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024