Provider Demographics
NPI:1437360195
Name:EXODUS RECOVERY INC
Entity Type:Organization
Organization Name:EXODUS RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOROHOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-945-3350
Mailing Address - Street 1:923 S CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4718
Mailing Address - Country:US
Mailing Address - Phone:310-792-5454
Mailing Address - Fax:310-792-5456
Practice Address - Street 1:923 S CATALINA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4718
Practice Address - Country:US
Practice Address - Phone:310-792-5454
Practice Address - Fax:310-792-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7248AMedicaid