Healthcare Provider Details

I. General information

NPI: 1902855240
Provider Name (Legal Business Name): NEXUS FAMILY HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N BRAMBLE ST
MANTENO IL
60950-9303
US

IV. Provider business mailing address

505 HIGHWAY 169 N SUITE 500
PLYMOUTH MN
55441-6434
US

V. Phone/Fax

Practice location:
  • Phone: 815-802-3700
  • Fax: 815-468-2320
Mailing address:
  • Phone: 763-551-8640
  • Fax: 763-553-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number22366804
License Number StateIL

VIII. Authorized Official

Name: JASON CLARK DUNNING
Title or Position: DIRECTOR OF FINANCIAL PLANNING
Credential:
Phone: 763-551-8664