Organization
REVIVE PATHWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDSON LEA (COO)
(619) 841-1310
Entity
Organization
Contact information
Practice address
1240 BROADWAY, EL CAJON, CA 92021-4994
(619) 841-1310
Mailing address
6650 GUNPARK DR, BOULDER, CO 80301-7002
(619) 841-1310
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
01/18/2023
Last updated
05/06/2026
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