MEDICARE: EXODUS SOBER LIVING HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1528787710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXODUS SOBER LIVING HOME

Provider Business Mailing Address
First Line	:	1730 EUCLID AVE # 859
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-5415
Country	:	US
Telephone Number	:	619-651-6322
Fax Number	:

Provider Business Practice Location Address
First Line	:	7625 NORTH AVE
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1629
Country	:	US
Telephone Number	:	619-651-6322
Fax Number	:

Authorized Official
Title or Position	:	WNER
Name	:	JAMES ELLIS BROWN
Credential	:
Telephone Number	:	619-651-6322

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

Similar Medicare Providers

1982644548 — DR. VANCY HOWARD BRIDGES M.D.
Practice Location Address:

1629 BROOK GROVE DR
EULESS, TX
76039-5269

Practice Phone: 214-830-1057
Practice Fax: 214-988-2505

1104156462 — MS. SHERRY LYNDA ROSA
Practice Location Address:

1629 S MAIN ST
GROVE, OK
74344-5368

Practice Phone: 918-791-9700
Practice Fax:

1578894234 — TONYA LYNN GOLDNER PSRS
Practice Location Address:

1629 S MAIN ST
GROVE, OK
74344-5368

Practice Phone: 918-791-9700
Practice Fax:

1750694782 — BRIAN DAVIS R.PH.
Practice Location Address:

1629 RESERVOIR AVE
WILLOW GROVE, PA
19090-4434

Practice Phone: 215-830-8747
Practice Fax: 215-830-8747

1285348086 — LIFE PRACTICE COUNSELING GROUP
Practice Location Address:

2787 GROVE AVE
SACRAMENTO, CA
95815-1629

Practice Phone: 916-300-6576
Practice Fax:

1891686580 — ALUMA CARE SERVICES LLC
Practice Location Address:

85 GROVE ST
SAINT PAUL, MN
55115-1629

Practice Phone: 651-529-4232
Practice Fax:

Directions to “EXODUS SOBER LIVING HOME ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.