18D2329056 CLIA NUMBER - REVIVE LIFE HOUSE

Laboratory Demographics

  • CLIA Code: 18D2329056
  • Facility Name: REVIVE LIFE HOUSE
  • Facility Address: 405 W MAPLE ST
    NICHOLASVILLE, KY
    ZIP 40356
  • Facility Phone: 859 881-4505
  • Facility Type: Other - RESIDENTIAL SUD TREATMENT
  • Facility Type: Waiver
  • Lab Director: MS. JENNIFER EMERY
  • NPI Number: 1891370185
  • Taxonomy: 103TA0400X - Psychologist

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CLIA Record

Field Name Field Value
CLIA Number 18D2329056
LAB Type Other - RESIDENTIAL SUD TREATMENT
Facility Name REVIVE LIFE HOUSE
Street 405 W MAPLE ST
City NICHOLASVILLE
State KY
ZIP 40356
Phone 859 881-4505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2025
Certificate Expiration Date 8/20/2027
Facility Type Other - RESIDENTIAL SUD TREATMENT
Lab Director MS. JENNIFER EMERY

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