NPIMap

Organization Active NPI

Exodus Recovery, Inc.

  • Community/Behavioral Health Agency
  • San Diego, CA
National Provider Identifier
1083943005
Registry record updated Jul 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EXODUS RECOVERY, INC.
Practice address
4308 30TH St
Suite a
San Diego, CA 92104-1314
Phone
(310) 945-3350
NPI assigned
Dec 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Leeann Skorohod
Title
Sr VP Operations
Phone
(310) 945-3350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

4308 30TH St
Suite a
San Diego, CA 92104-1314

Mailing address

9808 Venice Blvd
Suite 700
Culver City, CA 90232-2732
Phone (310) 945-3350

Other identifiers 1

IdentifierTypeStateIssuer
3220MedicaidCA

Other names 1

  • Exodus Central Connections Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100107000614 CA Part B Supplier - Clinic/Group Practice 2668467341 Receives reassigned benefits from 30 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; Lynwood, CA; Orange, CA; Redondo Beach, CA; Vista, CA; Fresno, CA; Culver City, CA

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373587200000",
    "number": "1083943005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9808 VENICE BLVD",
            "address_2": "SUITE 700",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322732",
            "telephone_number": "310-945-3350",
            "fax_number": "310-840-7023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4308 30TH ST",
            "address_2": "SUITE A",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921041314",
            "telephone_number": "310-945-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXODUS RECOVERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-22",
        "last_updated": "2013-07-12",
        "status": "A",
        "authorized_official_last_name": "SKOROHOD",
        "authorized_official_first_name": "LEEANN",
        "authorized_official_title_or_position": "SR VP OPERATIONS",
        "authorized_official_telephone_number": "310-945-3350",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3220",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Exodus Central Connections",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.