Provider Demographics
NPI:1164307922
Name:EXODUS FLEX HOLDING LLC
Entity type:Organization
Organization Name:EXODUS FLEX HOLDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:203-767-4666
Mailing Address - Street 1:22101 TOWN WALK DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3759
Mailing Address - Country:US
Mailing Address - Phone:203-767-4666
Mailing Address - Fax:
Practice Address - Street 1:22101 TOWN WALK DR
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3759
Practice Address - Country:US
Practice Address - Phone:203-767-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty