Provider Demographics
NPI:1457802852
Name:NEXUS
Entity Type:Organization
Organization Name:NEXUS
Other - Org Name:MILLE LACS ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:763-551-8640
Mailing Address - Street 1:407 130TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-3115
Mailing Address - Country:US
Mailing Address - Phone:320-532-4005
Mailing Address - Fax:320-532-4898
Practice Address - Street 1:407 130TH AVE S
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-3115
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:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities