NPIMap

Organization Active NPI

Exodus Recovery, Inc.

  • Community/Behavioral Health Agency
  • Fresno, CA
National Provider Identifier
1134858202
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EXODUS RECOVERY, INC.
Practice address
524 S Trinity St
Office & Community Room
Fresno, CA 93706-1873
Phone
(559) 538-1230
NPI assigned
Jun 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Authorized official

Name
Leeann Skorohod
Title
Coo
Phone
(310) 945-3350

Specialties & licenses 1

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

Addresses

Primary practice location

524 S Trinity St
Office & Community Room
Fresno, CA 93706-1873

Mailing address

9808 Venice Blvd Ste 700
Culver City, CA 90232-6824
Phone (310) 945-3350

Other names 1

  • Renaissance at Trinity 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

NPI Registry JSON

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

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654473600000",
    "number": "1134858202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9808 VENICE BLVD STE 700",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902326824",
            "telephone_number": "310-945-3350",
            "fax_number": "310-945-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 S TRINITY ST",
            "address_2": "OFFICE & COMMUNITY ROOM",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937061873",
            "telephone_number": "559-538-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXODUS RECOVERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-06",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A",
        "authorized_official_last_name": "SKOROHOD",
        "authorized_official_first_name": "LEEANN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "310-945-3350"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance at Trinity",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; 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.