Provider Demographics
NPI:1417623596
Name:NU HORIZONS OF SOUTHERN MN LLC
Entity Type:Organization
Organization Name:NU HORIZONS OF SOUTHERN MN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-386-8743
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:ELYSIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56028-0247
Mailing Address - Country:US
Mailing Address - Phone:612-386-8743
Mailing Address - Fax:
Practice Address - Street 1:107 PARK AVE NE
Practice Address - Street 2:
Practice Address - City:ELYSIAN
Practice Address - State:MN
Practice Address - Zip Code:56028-2041
Practice Address - Country:US
Practice Address - Phone:612-386-8743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA851678300Medicaid
MNM296987300Medicaid
MNA016698200Medicaid
MNA104640100Medicaid
MNA193658000Medicaid
MNA847930100Medicaid
MNA399148000Medicaid
MNA722960500Medicaid
MNA421408000Medicaid
MNA497458400Medicaid
MNA808132000Medicaid