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REVIVE PATHWAY
NPI 1962117440
Clinic/Center - Rehabilitation, Substance Use Disorder in El Cajon, CA

Active since January 18, 2023CLIA 05D2287034 · Waiver
1240 BROADWAY, EL CAJON, CA 92021(619) 841-1310 Get Directions Write a Review

NPPES record last updated: May 6, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 6, 2026, Jan 18, 2023 (2 updates tracked since 2023).

About Revive Pathway NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVIVE PATHWAY (NPI 1962117440) is a healthcare organization registered as a rehabilitation, substance use disorder in El Cajon, California and active in the NPI registry since January 2023. The organization holds a CLIA Waiver certificate valid through August 7, 2027 and lists Judson Lea, Coo, as its authorized official.

NPPES Registry Identity

NPI1962117440
Entity TypeOrganization
Primary Taxonomy261QR0405X
Legal Business NameREVIVE PATHWAY
Location Address1240 BROADWAYEl Cajon, CA 92021-4994
Mailing Address6650 Gunpark DrBoulder, CO 80301-7002 · (619) 841-1310
Phone(619) 841-1310
Organization SubpartNo
Authorized OfficialJudson LeaCoo · (619) 841-1310
Enumeration DateJanuary 18, 2023
Last NPPES UpdateMay 6, 20262 updates tracked since enumeration
NPPES CertifiedMay 6, 2026
✔ NPI 1962117440 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Rehabilitation, Substance Use DisorderAmbulatory Health Care Facilities
Taxonomy Code261QR0405X
Also ListedGeneral PracticeTaxonomy 208D00000X
Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X
1240 BROADWAY, El Cajon, CA 92021
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2287034

Revive Pathway · El Cajon, CA
Active · expires Aug 7, 2027
CLIA Number05D2287034
Laboratory TypeSubstance Use Disorder
Certificate Effective DateAugust 8, 2025
Certificate Expiration DateAugust 7, 2027
Laboratory DirectorWaseem M. Khader, D.O.
Laboratory Phone(619) 841-1310
Laboratory LocationRevive Pathway1240 Broadway, El Cajon, CA 92021
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PRACHI AVINASH KARNIK M.D.
Internal Medicine
1240 BROADWAY
EL CAJON, CA 92021
San Diego County (858) 499-2600
ASHLEY SMITH
Physician Assistant
1240 BROADWAY
EL CAJON, CA 92021
San Diego County (619) 841-1310
MICHELLE WILCOX FNP
Nurse Practitioner
1240 BROADWAY
EL CAJON, CA 92021
San Diego County (619) 841-1310
DR. REBECCA RENEE SMITH MD
Family Medicine
1240 BROADWAY
EL CAJON, CA 92021
San Diego County (858) 499-2600
LAKAI MONEE BANKS-DEAN MD
Family Medicine (Addiction Medicine)
1240 BROADWAY
EL CAJON, CA 92021
San Diego County (619) 841-1310
RONALD S. KWOK M.D.
Internal Medicine
1240 BROADWAY
EL CAJON, CA 92021
San Diego County (858) 499-2269
MS. ATAA B MATY NP
Nurse Practitioner (Psychiatric/Mental Health)
1240 BROADWAY
EL CAJON, CA 92021
San Diego County (619) 981-8887
DR. PAUL EDWARD VERHOEVE M.D.
Specialist
1240 BROADWAY, #201
EL CAJON, CA 92021
San Diego County (619) 588-9355

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revive Pathway's NPI number?

The NPI number for Revive Pathway is 1962117440. It was assigned to this organization in the NPPES registry on January 18, 2023.

Where is Revive Pathway located?

Revive Pathway is located at 1240 Broadway, El Cajon, CA 92021. The listed phone number is (619) 841-1310.

What is Revive Pathway's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Substance Use Disorder, with taxonomy code 261QR0405X.

Does Revive Pathway hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2287034) is associated with this NPI, valid through August 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Revive Pathway was last updated on May 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.