REVIVE PATHWAY
NPI 1962117440
Clinic/Center - Rehabilitation, Substance Use Disorder in El Cajon, CA
NPI Status: Active since January 18, 2023
Contact Information
1240 BROADWAY
EL CAJON, CA
ZIP 92021
Phone: (619) 841-1310
- Organization
- Clinic/Center
- Rehabilitation, Substance Use Disorder
- CLIA Number: 05D2287034
- CLIA Cert. Type: Other - SUBSTANCE USE DISORDER
- CLIA Exp. Date: 08-07-2027
About REVIVE PATHWAY
This page provides the complete NPI Profile along with additional information for Revive Pathway, a provider established in El Cajon, California operating as a Clinic/center, focusing in rehabilitation, substance use disorder . The healthcare provider is registered in the NPI registry with number 1962117440 assigned on January 2023. The practitioner's primary taxonomy code is 261QR0405X. The provider is registered as an organization and their NPI record was last updated May 2026. The authorized official of this NPI record is Judson Lea (Coo)
- NPI
- 1962117440
- Provider Name
- REVIVE PATHWAY
- Entity Type
- Organization
- Location Address
- 1240 BROADWAY EL CAJON, CA 92021
- Location Phone
- (619) 841-1310
- Mailing Address
- 6650 GUNPARK DR BOULDER, CO 80301
- Mailing Phone
- (619) 841-1310
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-18-2023
- Last Update Date
- 05-06-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Rehabilitation, Substance Use Disorder
- Taxonomy Code
- 261QR0405X
- Type
- Ambulatory Health Care Facilities
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | |
| 2 | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 05D2287034
- Facility Type
- Other - SUBSTANCE USE DISORDER
- Certificate Effective Date
- August 08, 2025
- Certificate Expiration Date
- August 07, 2027
- Laboratory Director
- WASEEM M. KHADER, D.O.
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Revive Pathway to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1962117440, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 60. The final step is to find the difference between that total and the next multiple of ten (60 - 60 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 60 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 14 providers are registered at the same or a nearby location.
EL CAJON, CA 92021
EL CAJON, CA 92021
EL CAJON, CA 92021
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1962117440, enumerated as an "organization" on January 18, 2023.
The provider is located at 1240 BROADWAY EL CAJON, CA 92021 and the phone number is (619) 841-1310.
Clinic/Center with taxonomy code 261QR0405X and a focus in Rehabilitation, Substance Use Disorder.
