Provider Demographics
NPI:1811193188
Name:NEXUS
Entity Type:Organization
Organization Name:NEXUS
Other - Org Name:NEXUS - MILLE LACS ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-551-8669
Mailing Address - Street 1:4050 OLSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5323
Mailing Address - Country:US
Mailing Address - Phone:763-551-8659
Mailing Address - Fax:763-553-1637
Practice Address - Street 1:100 CROSIER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-4512
Practice Address - Country:US
Practice Address - Phone:320-532-4005
Practice Address - Fax:320-532-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1036935-1-CRF3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5160492Medicaid
SD5160493Medicaid
4C72MIOtherBLUE CROSS BLUE SHIELD
SD5160490Medicaid