Healthcare Provider Details

I. General information

NPI: 1811572886
Provider Name (Legal Business Name): NEXUS-PATH FAMILY HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 5TH AVE S
FARGO ND
58103-1539
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 701-232-8905
  • Fax:
Mailing address:
  • Phone: 218-280-9545
  • Fax: 701-280-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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