Healthcare Provider Details

I. General information

NPI: 1831052158
Provider Name (Legal Business Name): EXODUS 23 REAL ESTATE COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E LAVERNE ST
BOLIVAR MO
65613-1488
US

IV. Provider business mailing address

2732 N OAK PARK DR
SPRINGFIELD MO
65803-2084
US

V. Phone/Fax

Practice location:
  • Phone: 417-763-0704
  • Fax: 417-427-3671
Mailing address:
  • Phone: 417-763-0704
  • Fax: 417-427-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPHAT K BITOK
Title or Position: OWNER
Credential:
Phone: 417-763-0704