36D2183469 CLIA NUMBER - REVITALIZED BEHAVIORAL HEALTHCARE LLC

Laboratory Demographics

  • CLIA Code: 36D2183469
  • Facility Name: REVITALIZED BEHAVIORAL HEALTHCARE LLC
  • Facility Address: 5577 AIRPORT HWY, SUITE 102
    TOLEDO, OH
    ZIP 43615
  • Facility Phone: 419 214-1770
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: SAMANTHA S. NANCE
  • NPI Number: 1013543040
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 36D2183469
LAB Type Comp. Outpatient Rehab Facility
Facility Name REVITALIZED BEHAVIORAL HEALTHCARE LLC
Street 5577 AIRPORT HWY, SUITE 102
City TOLEDO
State OH
ZIP 43615
Phone 419 214-1770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/6/2024
Certificate Expiration Date 5/5/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director SAMANTHA S. NANCE

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