36D2326643 CLIA NUMBER - REVIVE BEHAVIORAL HEALTH

Laboratory Demographics

  • CLIA Code: 36D2326643
  • Facility Name: REVIVE BEHAVIORAL HEALTH
  • Facility Address: 206 S MULBERRY STREET, SUITE A
    MOUNT VERNON, OH
    ZIP 43050
  • Facility Phone: 740 326-9988
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JORDAN R. MOORE
  • NPI Number: 1003601220
  • Taxonomy: 363LP0808X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 36D2326643
LAB Type Physician Office
Facility Name REVIVE BEHAVIORAL HEALTH
Street 206 S MULBERRY STREET, SUITE A
City MOUNT VERNON
State OH
ZIP 43050
Phone 740 326-9988
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2025
Certificate Expiration Date 7/7/2027
Facility Type Physician Office
Lab Director JORDAN R. MOORE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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