1649610841 NPI number — NEXUS FAMILY HEALING

Table of content: (NPI 1649610841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649610841 NPI number — NEXUS FAMILY HEALING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEXUS FAMILY HEALING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEXUS-INDIAN OAKS FAMILY HEALING
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649610841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 HIGHWAY 169 N STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55441-6447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-551-8640
Provider Business Mailing Address Fax Number:
763-553-1637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 HEMLOCK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANTENO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-802-3700
Provider Business Practice Location Address Fax Number:
815-468-2320
Provider Enumeration Date:
07/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DUNNING
Authorized Official First Name:
JASON
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
DIRECTOR OF FINANCIAL PLANNING
Authorized Official Telephone Number:
763-551-8664

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 322D00000X , with the licence number: 223668-06 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2B05-IPI-051 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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