Healthcare Provider Details

I. General information

NPI: 1326641671
Provider Name (Legal Business Name): EXODUS RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 12/05/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S ANITA DR STE 102-104
ORANGE CA
92868-3355
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 714-410-3500
  • Fax: 714-410-3525
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