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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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1528742269
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXODUS RECOVERY, INC.
Provider Business Mailing Address
First Line : 9808 VENICE BLVD STE 700
Second Line :
City : CULVER CITY
State : CA
Zip : 90232-6824
Country : US
Telephone Number : 310-945-3350
Fax Number : 310-945-3355
Provider Business Practice Location Address
First Line : 130 W BARSTOW AVE
Second Line :
City : FRESNO
State : CA
Zip : 93704-2156
Country : US
Telephone Number : 559-538-1727
Fax Number : 559-538-1725
Authorized Official
Title or Position : CFO
Name : MS. LEEANN SKOROHOD
Credential :
Telephone Number : 310-945-3350
Provider Enumeration Date : 06/13/2023
Last Update Date : 06/13/2023

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