Provider Demographics
NPI:1457042897
Name:EXODUS HOME CARE COMPANY
Entity Type:Organization
Organization Name:EXODUS HOME CARE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-246-5725
Mailing Address - Street 1:6904 PLEASANT GROVE RD # B183
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1319
Mailing Address - Country:US
Mailing Address - Phone:980-246-5725
Mailing Address - Fax:
Practice Address - Street 1:809 WESTMERE AVE # B183
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5342
Practice Address - Country:US
Practice Address - Phone:980-316-6034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care