Healthcare Provider Details

I. General information

NPI: 1811109812
Provider Name (Legal Business Name): NEXUS-PATH FAMILY HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/21/2022
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 WESTRAC DR S STE 400
FARGO ND
58103-2356
US

IV. Provider business mailing address

1202 WESTRAC DR S STE 400
FARGO ND
58103-2356
US

V. Phone/Fax

Practice location:
  • Phone: 701-280-9545
  • Fax: 701-451-9473
Mailing address:
  • Phone: 701-280-9545
  • Fax: 701-280-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateND

VIII. Authorized Official

Name: KAREN BAUKOL
Title or Position: HR DIRECTOR
Credential: PHR
Phone: 701-551-6318