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NPI Code Detail

MEDICARE: EXODUS RECOVERY INC

MEDICARE: EXODUS RECOVERY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2251X00000XSupports Brokerage Agency
3261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
4251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437360195
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXODUS RECOVERY INC
Provider Business Mailing Address
First Line : 923 S CATALINA AVE
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-4718
Country : US
Telephone Number : 310-792-5454
Fax Number : 310-792-5456
Provider Business Practice Location Address
First Line : 923 S CATALINA AVE
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-4718
Country : US
Telephone Number : 310-792-5454
Fax Number : 310-792-5456
Authorized Official
Title or Position : COO
Name : LEEANN SKOROHOD
Credential :
Telephone Number : 310-945-3350
Provider Enumeration Date : 05/24/2007
Last Update Date : 03/03/2022

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Directions to “EXODUS RECOVERY INC ” Practice Location

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