Provider Demographics
NPI:1346370640
Name:ACHIEVE THERAPY LLC
Entity Type:Organization
Organization Name:ACHIEVE THERAPY LLC
Other - Org Name:ACHIEVE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, PTA
Authorized Official - Phone:701-746-8374
Mailing Address - Street 1:3035 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4040
Mailing Address - Country:US
Mailing Address - Phone:701-746-6694
Mailing Address - Fax:701-746-6894
Practice Address - Street 1:3035 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4040
Practice Address - Country:US
Practice Address - Phone:701-746-6694
Practice Address - Fax:701-746-6894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54651Medicaid
ND6037001OtherBCBSND
ND135104OtherPREFFERED ONE
ND4970240002OtherBCBSND
MN006613301Medicaid
ND2135134OtherFIRST HEALTH
MN322R6SEOtherBCBSMN
ND54651Medicaid
ND=========002OtherTRICARE
MN006613301Medicaid
NDN711248Medicare PIN