Provider Demographics
NPI:1578733671
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 OFFICE MANAGER
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:PO BOX 12938
Mailing Address - Street 2:1425 S COLUMBIA RD
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58208-2938
Mailing Address - Country:US
Mailing Address - Phone:701-746-8374
Mailing Address - Fax:
Practice Address - Street 1:829 LAKE AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3017
Practice Address - Country:US
Practice Address - Phone:218-844-5340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN183H5SEOtherBCBS MN
MN183H5SEOtherBCBS MN