Provider Demographics
NPI:1669092201
Name:EXODUS RECOVERY SERVICES LLC.
Entity type:Organization
Organization Name:EXODUS RECOVERY SERVICES LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP-R, CADCIII
Authorized Official - Phone:541-952-1719
Mailing Address - Street 1:230 N 3RD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9679
Mailing Address - Country:US
Mailing Address - Phone:541-998-5660
Mailing Address - Fax:541-998-5678
Practice Address - Street 1:230 N 3RD ST STE 105
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:OR
Practice Address - Zip Code:97446-9679
Practice Address - Country:US
Practice Address - Phone:541-998-5660
Practice Address - Fax:541-998-5678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXODUS RECOVERY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-23
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty