Provider Demographics
NPI:1114171642
Name:EXODUS RECOVERY INC
Entity Type:Organization
Organization Name:EXODUS RECOVERY INC
Other - Org Name:EXODUS MENTAL HEALTH WALK-IN CTR - ESCONDIDO
Other - Org Type:Other Name
Authorized Official - Title/Position:SR VP, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOROHOD
Authorized Official - Suffix:
Authorized Official - Credentials:CHC
Authorized Official - Phone:310-945-3350
Mailing Address - Street 1:9808 VENICE BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6824
Mailing Address - Country:US
Mailing Address - Phone:310-945-3350
Mailing Address - Fax:310-840-7023
Practice Address - Street 1:1520 S ESCONDIDO BLVD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6017
Practice Address - Country:US
Practice Address - Phone:760-746-1146
Practice Address - Fax:760-796-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37LCMedicaid