Provider Demographics
NPI:1386829190
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:701-952-5187
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:701-952-5154
Practice Address - Street 1:605 3RD ST NW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2965
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:2007-12-31
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30875Medicaid