MEDICARE: NEXUS RECOVERY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1669991568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXUS RECOVERY SERVICES, LLC

Provider Business Mailing Address
First Line	:	11515 WASHINGTON BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90066-5913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11515 WASHINGTON BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90066
Country	:	US
Telephone Number	:	310-994-3093
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	HALIM DANIEL
Credential	:
Telephone Number	:	310-994-3093

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	09/25/2017

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