Healthcare Provider Details

I. General information

NPI: 1376308791
Provider Name (Legal Business Name): NEXUS RESIDENTIAL HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 INDUSTRIAL ST APT 9
HUDSON WI
54016-9150
US

IV. Provider business mailing address

1801 INDUSTRIAL ST APT 9
HUDSON WI
54016-9150
US

V. Phone/Fax

Practice location:
  • Phone: 612-987-8534
  • Fax:
Mailing address:
  • Phone: 612-987-8534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMEEL ABDELRASHID MOHAMED
Title or Position: OWNER
Credential:
Phone: 612-987-8534