Healthcare Provider Details

I. General information

NPI: 1700259942
Provider Name (Legal Business Name): EXODUS TRANSITIONAL COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2276 3RD AVE
NEW YORK NY
10035-2209
US

IV. Provider business mailing address

2271 3RD AVE 2ND FLOOR
NEW YORK NY
10035-2231
US

V. Phone/Fax

Practice location:
  • Phone: 917-492-0990
  • Fax: 212-722-6669
Mailing address:
  • Phone: 917-492-0990
  • Fax: 212-722-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS PAYTON
Title or Position: ASSOCIATE DIRECTOR
Credential: LCSW
Phone: 917-492-0990