Provider Demographics
NPI:1265202154
Name:EXODUS SCHOLAR HOMES
Entity type:Organization
Organization Name:EXODUS SCHOLAR HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MONYALLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-544-5912
Mailing Address - Street 1:2617 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1332
Mailing Address - Country:US
Mailing Address - Phone:502-544-5912
Mailing Address - Fax:
Practice Address - Street 1:2617 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1332
Practice Address - Country:US
Practice Address - Phone:502-544-5912
Practice Address - Fax:502-333-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty