Healthcare Provider Details

I. General information

NPI: 1598579005
Provider Name (Legal Business Name): EXODUS RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 MARENGO ST STE 200A
LOS ANGELES CA
90033-1382
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 323-276-6465
  • Fax: 323-276-8018
Mailing address:
  • Phone: 310-945-3350
  • Fax: 310-945-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

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