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General NPI Number Information
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NPI Number | 1851787188
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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 | 04/14/2015
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 4411 E KINGS CANYON RD
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City | FRESNO
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State | CA
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Zip | 93702-3604
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Country | US
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Telephone | 559-453-1008
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Fax | 559-453-2805
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Provider Business Mailing Address
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Address Line | 9808 VENICE BLVD STE 700
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City | CULVER CITY
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State | CA
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Zip | 90232-6824
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Country | US
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Telephone | 310-945-3350
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Fax | 310-945-3355
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Authorized Official
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Title or Position | COO/CFO
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Name | LEEANN SKOROHOD
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Credential | CCEP
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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 | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 771162
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License Number State | MN
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