Organization
NEXUS
Active
Parent organization
FEIN
Other names
SERCC-Nexus
Organization subpart
Yes
Provider details
NPI number
Legal business name
FEIN
Authorized official
LISA ASPER (CONTRACT MANAGER)
(763) 226-8397
Entity
Organization
Contact information
Practice address
2121 CAMPUS DR SE, ROCHESTER, MN 55904-4744
(763) 551-8640
Mailing address
2121 CAMPUS DR SE, ROCHESTER, MN 55904-4744
(763) 551-8640
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-1111111
FEE FOR SERVICE
MN
05
—
22-2222222
—
MN
Enumeration date
09/02/2020
Last updated
11/10/2021
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