MEDICARE: NEXUS WELLNESS CLINIC, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	324500000X	Substance Abuse Rehabilitation Facility
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261Q00000X	Clinic/Center
4	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1922995877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXUS WELLNESS CLINIC, LLC

Provider Business Mailing Address
First Line	:	PO BOX 803
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49468-0803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 W CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2105
Country	:	US
Telephone Number	:	602-980-3862
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	WESLEY E EMERT
Credential	:
Telephone Number	:	602-980-3862

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/11/2026

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