Provider Demographics
NPI:1811109812
Name:NEXUS-PATH FAMILY HEALING
Entity type:Organization
Organization Name:NEXUS-PATH FAMILY HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUKOL
Authorized Official - Suffix:
Authorized Official - Credentials:PHR
Authorized Official - Phone:701-551-6318
Mailing Address - Street 1:1202 WESTRAC DR S STE 400
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2356
Mailing Address - Country:US
Mailing Address - Phone:701-280-9545
Mailing Address - Fax:701-280-0038
Practice Address - Street 1:1202 WESTRAC DR S STE 400
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2356
Practice Address - Country:US
Practice Address - Phone:701-280-9545
Practice Address - Fax:701-451-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND104100000X, 1041C0700X, 251B00000X, 251S00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1472588Medicaid
ND1459674Medicaid