Provider Demographics
NPI:1902855240
Name:NEXUS FAMILY HEALING
Entity Type:Organization
Organization Name:NEXUS FAMILY HEALING
Other - Org Name:NEXUS-INDIAN OAKS FAMILY HEALING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL PLANNING
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-551-8664
Mailing Address - Street 1:505 HIGHWAY 169 N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6434
Mailing Address - Country:US
Mailing Address - Phone:763-551-8640
Mailing Address - Fax:763-553-1637
Practice Address - Street 1:101 N BRAMBLE ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-9303
Practice Address - Country:US
Practice Address - Phone:815-802-3700
Practice Address - Fax:815-468-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
IL22366804322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8585407Medicaid
NJ8585431Medicaid
NV100507833Medicaid
IL2B05-IPI-051Medicaid
IL3B00IPI051Medicaid
KY45001914Medicaid
NJ8585440Medicaid
IL=========850Medicaid
NJ8585407Medicaid
NJ8585431Medicaid