Healthcare Provider Details

I. General information

NPI: 1851787188
Provider Name (Legal Business Name): EXODUS RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 559-453-1008
  • Fax: 559-453-2805
Mailing address:
  • Phone: 310-945-3350
  • Fax: 310-945-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number771162
License Number StateMN

VIII. Authorized Official

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