Provider Demographics
NPI:1407241359
Name:EXODUS
Entity Type:Organization
Organization Name:EXODUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-246-1963
Mailing Address - Street 1:1685 N HOMSY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-3725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1685 N HOMSY AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-3725
Practice Address - Country:US
Practice Address - Phone:559-246-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA163WPO808X261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA163WPO808XOtherTAXONOMY
CA163WPO808XOtherEXODUS