Provider Demographics
NPI:1356117931
Name:NEXUS FAMILY HEALING
Entity type:Organization
Organization Name:NEXUS FAMILY HEALING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE CONTROLLER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VARBLE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:763-551-8640
Mailing Address - Street 1:505 HIGHWAY 169 N STE 500
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6447
Mailing Address - Country:US
Mailing Address - Phone:161-261-9016
Mailing Address - Fax:
Practice Address - Street 1:881 NE 162ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97320
Practice Address - Country:US
Practice Address - Phone:763-551-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXUS FAMILY HEALING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-27
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility