Provider Demographics
NPI:1316117542
Name:ANNE CARLSEN CENTER
Entity type:Organization
Organization Name:ANNE CARLSEN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-252-3850
Mailing Address - Street 1:701 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-2963
Mailing Address - Country:US
Mailing Address - Phone:701-252-3850
Mailing Address - Fax:
Practice Address - Street 1:701 3RD ST NW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2963
Practice Address - Country:US
Practice Address - Phone:701-252-3850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE CARLSEN CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND85522261QD1600X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND85522Medicaid