Healthcare Provider Details

I. General information

NPI: 1053598979
Provider Name (Legal Business Name): EXODUS RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W VISTA WAY STE 109
VISTA CA
92083-5707
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax: 310-840-7023
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
Credential:
Phone: 310-945-3350