Provider Demographics
NPI:1689960262
Name:EXODUS HOUSE, LLC
Entity Type:Organization
Organization Name:EXODUS HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-891-7320
Mailing Address - Street 1:3000 LASALLE ST
Mailing Address - Street 2:3012 NEWTONS CREST CIR
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5706
Mailing Address - Country:US
Mailing Address - Phone:504-891-7320
Mailing Address - Fax:504-891-7337
Practice Address - Street 1:3000 LASALLE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-5706
Practice Address - Country:US
Practice Address - Phone:504-891-7320
Practice Address - Fax:504-891-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness