EXODUS RECOVERY, INC. (NPI# 1740771559) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740771559 |
| Entity Type | Organization |
| Organization Name | EXODUS RECOVERY, INC. |
| Other Organization Name | EXODUS MLK ICC CTT |
| Practice Address |
12021 S Wilmington Ave Fl 2 Ic1-ic7 Los Angeles CA 90059-3019 |
| Mailing Address |
9808 Venice Blvd Ste 700 Culver City CA 90232-6824 |
| Practice Telephone | 5622955916 |
| Practice Fax Number | 5622955965 |
| Mailing Telephone | 3109453350 |
| Mailing Fax Number | 3109453355 |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2019-01-15 |
| Authorized Official Name | LEEANN SKOROHOD (COO) |
| Authorized Official Telephone | 3109453350 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| Exodus CTT at MLK | Other Name - Individual/Organization |
| Exodus MLK ICC CTT | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184272395 | Exodus Recovery, Inc. | Community/Behavioral Health | 550 W Vista Way Ste 204, Vista, CA 92083-5736 | 2019-08-30 |
| 1124596291 | Exodus Recovery, Inc. | Community/Behavioral Health | 550 W Vista Way Ste 109, Vista, CA 92083-5707 | 2018-11-07 |
| 1104307164 | Exodus Recovery, Inc. | Community/Behavioral Health | 1000 W Carson St Rm 2022, Bldg 2 South, Torrance, CA 90502-2004 | 2018-08-27 |
| 1184169815 | Exodus Recovery, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3754-56 Overland Ave, Los Angeles, CA 90034-6312 | 2017-01-04 |
| 1356711436 | Exodus Recovery, Inc. | Community/Behavioral Health | 8513 S Vermont Ave, Los Angeles, CA 90044-3425 | 2015-10-01 |
| 1083943005 | Exodus Recovery, Inc. | Community/Behavioral Health | 4308 30th St, Suite A, San Diego, CA 92104-1314 | 2009-12-22 |
| 1053598979 | Exodus Recovery, Inc. | Community/Behavioral Health | 524 W Vista Way # 55, Vista, CA 92083-5704 | 2008-01-22 |
| 1437704806 | Exodus Recovery, Inc. | Community/Behavioral Health | 11905 S Central Ave Ste 303, Los Angeles, CA 90059-2897 | 2019-08-02 |
| 1235600545 | Exodus Recovery, Inc. | Community/Behavioral Health | 1520 S Escondido Blvd, Escondido, CA 92025-6017 | 2018-12-12 |
| 1114418928 | Exodus Recovery, Inc. | Community/Behavioral Health | 12021 Wilmington Ave, Los Angeles, CA 90059-3019 | 2018-05-29 |
| Street Address |
12021 S WILMINGTON AVE FL 2 IC1-IC7 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90059-3019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235759788 | Juan Jimenez Jr. | Technician, Pathology | 1860 E 120th St, Los Angeles, CA 90059 | 2020-04-24 |
| 1538717780 | Donald O Nwanze | Pharmacist | Mlk Outpatient Center (pharmacy), 1670 East 120th Street, Los Angeles, CA 90059 | 2019-08-30 |
| 1295391050 | Sheela Hoyle | Counselor | 836 East Saucer Lane, Los Angeles, CA 90059 | 2019-05-16 |
| 1750852471 | Carlos Tovar Sr. | Community Health Worker | 1720 E 120st, Los Angeles, CA 90059 | 2018-12-06 |
| 1699293910 | Amy Caryn Bolenbaugh | Recreation Therapist | 1720 E 120th Street, Los Angeles, CA 90059 | 2017-09-07 |
| 1417475757 | Scott Lee Jones | Recreation Therapist | Augustus F. Hawkins, 1720 E. 120th Street, Rm. 2196, Los Angeles, CA 90059 | 2017-09-07 |
| 1881118859 | Darlene Renee Tillman | Speech-Language Pathologist | 1670 E 120th Strret, Los Angeles, CA 90059 | 2017-08-01 |
| 1609306430 | Valda Therese Flores | Registered Nurse | 1670 E. 120th Street, Los Angeles, CA 90059 | 2017-06-14 |
| 1093244006 | Bongsill Chung | Registered Nurse | 1670 East 120th St, Los Angeles, CA 90059 | 2017-06-05 |
| 1730573395 | Apollonia Godoy | Registered Nurse | 1670 E. 120th St, 4th Floor, Module A, Los Angeles, CA 90059 | 2015-03-22 |
| Find all providers in zip 90059 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740881861 | Griselda Tuchan Pineda Marriage and Family Therapist Inc | Community/Behavioral Health | 2820 S Vermont Ave Ste 16, Los Angeles, CA 90007-2291 | 2020-11-04 |
| 1376142216 | Melissa Reyes Aguilar | Community/Behavioral Health | 2248 S Cochran Ave, Los Angeles, CA 90016-1218 | 2020-10-21 |
| 1841807666 | Didi Hirsch Psychiatric Service | Community/Behavioral Health | 10101 S Broadway, Los Angeles, CA 90003-4534 | 2020-09-25 |
| 1730795188 | Connect Therapies | Community/Behavioral Health | 801 S Beverly Glen Blvd, Los Angeles, CA 90024-4603 | 2020-09-21 |
| 1396358735 | United Therapy Center,inc | Community/Behavioral Health | 12777 W Jefferson Blvd # D3020, Los Angeles, CA 90066-7048 | 2020-08-25 |
| 1174149769 | Amanecer Community Counseling Service, A Non-profit Corporation | Community/Behavioral Health | 3750 W 6th St, Los Angeles, CA 90020-5100 | 2020-06-19 |
| 1902421290 | Exceptional Wellness of California Incorporated | Community/Behavioral Health | 626 Wilshire Blvd Ste 410, Los Angeles, CA 90017-2915 | 2020-06-11 |
| 1043831878 | Didi Hirsch Psychiatric Service | Community/Behavioral Health | 9179 S Main Street, Los Angeles, CA 90003 | 2020-05-04 |
| 1780226977 | Children's Institute, Inc. | Community/Behavioral Health | 7001 S St Andrews Pl, Los Angeles, CA 90047-1833 | 2019-10-09 |
| 1780238675 | Igcn Healthcare Partners | Community/Behavioral Health | 6153 Colgate Ave, Los Angeles, CA 90036-3127 | 2019-07-29 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90059 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.