Provider Demographics
NPI:1063773174
Name:NEXUS FAMILY HEALING
Entity type:Organization
Organization Name:NEXUS FAMILY HEALING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:FORBORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-532-4005
Mailing Address - Street 1:407 130TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-3115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 130TH AVE S
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-3115
Practice Address - Country:US
Practice Address - Phone:320-532-4005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXUS FAMILY HEALING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-05
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1036935-2-CRF103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1700958881OtherNPI FOR RESIDENTIAL TREATMENT FACILITY