Healthcare Provider Details

I. General information

NPI: 1568771236
Provider Name (Legal Business Name): EXODUS RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MARENGO ST
LOS ANGELES CA
90033-1317
US

IV. Provider business mailing address

9808 VENICE BLVD SUITE 700
CULVER CITY CA
90232-2732
US

V. Phone/Fax

Practice location:
  • Phone: 323-276-6400
  • Fax: 323-276-6499
Mailing address:
  • Phone: 310-945-3350
  • Fax: 310-840-7023

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/CFO
Credential:
Phone: 310-945-3350