MEDICARE: NEXUS FAMILY HEALING

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	209700-07	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209700-09	OTHER	IL	DEPARTMENT OF CHILDREN AND FAMILY SERVICES

General Provider Information

NPI Number	:	1942579743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXUS FAMILY HEALING

Provider Business Mailing Address
First Line	:	505 HIGHWAY 169 N
Second Line	:	500
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-6434
Country	:	US
Telephone Number	:	763-551-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 N LOCUST ST
Second Line	:
City	:	ONARGA
State	:	IL
Zip	:	60955-1213
Country	:	US
Telephone Number	:	815-268-4001
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCIAL PLANNING
Name	:	JASON CLARK DUNNING
Credential	:
Telephone Number	:	763-551-8664

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	12/10/2020

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Directions to “NEXUS FAMILY HEALING ” Practice Location

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