Provider Demographics
NPI:1750542478
Name:ANNE CARLSEN CENTER FOR CHILDREN
Entity type:Organization
Organization Name:ANNE CARLSEN CENTER FOR CHILDREN
Other - Org Name:<UNAVAIL>
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:PO BOX 8000
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58402-8000
Mailing Address - Country:US
Mailing Address - Phone:701-252-3850
Mailing Address - Fax:701-952-5154
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:701-952-5154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE CARLSEN CENTER FOR CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-25
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND85200Medicaid