Healthcare Provider Details

I. General information

NPI: 1295465557
Provider Name (Legal Business Name): EXODUS RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 PLAZA DRIVE W ROOMS 105, 106B AND COMMUNITY ROOM
FRESNO CA
93702-1364
US

IV. Provider business mailing address

9808 VENICE BLVD STE 700
CULVER CITY CA
90232-6824
US

V. Phone/Fax

Practice location:
  • Phone: 559-538-1230
  • Fax:
Mailing address:
  • Phone: 310-945-3350
  • Fax: 310-945-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LEEANN SKOROHOD
Title or Position: COO
Credential:
Phone: 310-945-3350