Provider Demographics
NPI:1588922991
Name:EXODUS HOME
Entity type:Organization
Organization Name:EXODUS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH MANAGER
Authorized Official - Phone:617-794-2939
Mailing Address - Street 1:246 SEAVER ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1519
Mailing Address - Country:US
Mailing Address - Phone:617-541-8800
Mailing Address - Fax:617-541-8880
Practice Address - Street 1:246 SEAVER ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1519
Practice Address - Country:US
Practice Address - Phone:617-541-8800
Practice Address - Fax:617-541-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52621385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child