Healthcare Provider Details

I. General information

NPI: 1407241359
Provider Name (Legal Business Name): EXODUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 N HOMSY AVE
CLOVIS CA
93619-3725
US

IV. Provider business mailing address

1685 N HOMSY AVE
CLOVIS CA
93619-3725
US

V. Phone/Fax

Practice location:
  • Phone: 559-246-1963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number163WPO808X
License Number StateCA

VIII. Authorized Official

Name: JULIA C ARMAS
Title or Position: RN
Credential:
Phone: 559-246-1963