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General NPI Number Information
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NPI Number | 1245441906
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Entity Type | Organization
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Legal Business Name | EXODUS RECOVERY INC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 8401 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-3423
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Country | US
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Telephone | 323-789-6492
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Fax | 323-967-0180
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Provider Business Mailing Address
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Address Line | 8401 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-3423
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Country | US
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Telephone | 323-789-6492
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Fax | 323-967-0180
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Authorized Official
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Title or Position | COO
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Name | LEEANN SKOROHOD
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Credential |
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Telephone | 310-945-3350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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