MEDICARE: EXODUS RECOVERY, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1740771559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXODUS RECOVERY, INC.

Provider Business Mailing Address
First Line	:	9808 VENICE BLVD STE 700
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6824
Country	:	US
Telephone Number	:	310-945-3350
Fax Number	:	310-945-3355

Provider Business Practice Location Address
First Line	:	12021 S WILMINGTON AVE BLDG 18 STE 100
Second Line	:	ROOMS 1106, 1109, 1113, 1115, 1116, 1119, 1125, 1129
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	562-295-5916
Fax Number	:	562-295-5965

Authorized Official
Title or Position	:	COO
Name	:	LEEANN SKOROHOD
Credential	:
Telephone Number	:	310-945-3350

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	04/25/2023

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Directions to “EXODUS RECOVERY, INC. ” Practice Location

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