Organization
NEXUS
Active
Other names
Nexus - Mille Lacs Academy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES D'ANGELO (CEO)
(763) 551-8669
Entity
Organization
Contact information
Practice address
100 CROSIER DR, SUITE 1, ONAMIA, MN 56359-4512
(320) 532-4005
(320) 532-4898
Mailing address
4050 OLSON MEMORIAL HWY, SUITE 450, MINNEAPOLIS, MN 55422-5323
(763) 551-8659
(763) 553-1637
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
1036935-1-CRF
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4C72MI
BLUE CROSS BLUE SHIELD
—
05
—
5160490
—
SD
05
—
5160492
—
SD
05
—
5160493
—
SD
Enumeration date
06/25/2007
Last updated
08/22/2020
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