=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831052158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXODUS 23 REAL ESTATE COMPANY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1830 E LAVERNE ST
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65613-1488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-763-0704
-----------------------------------------------------
Fax | 417-427-3671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2732 N OAK PARK DR
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65803-2084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-763-0704
-----------------------------------------------------
Fax | 417-427-3671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOSEPHAT K BITOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 417-763-0704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------