Healthcare Provider Details

I. General information

NPI: 1922605443
Provider Name (Legal Business Name): EXODUS BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 FREEMAN ST
BALTIMORE MD
21225-1925
US

IV. Provider business mailing address

700 WASHINGTON BLVD
BALTIMORE MD
21230-2350
US

V. Phone/Fax

Practice location:
  • Phone: 617-593-3333
  • Fax:
Mailing address:
  • Phone: 617-593-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES APELSTEIN
Title or Position: CEO
Credential:
Phone: 410-343-4343