Healthcare Provider Details

I. General information

NPI: 1316117542
Provider Name (Legal Business Name): ANNE CARLSEN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 3RD ST NW
JAMESTOWN ND
58401-2963
US

IV. Provider business mailing address

701 3RD ST NW
JAMESTOWN ND
58401-2963
US

V. Phone/Fax

Practice location:
  • Phone: 701-252-3850
  • Fax:
Mailing address:
  • Phone: 701-252-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number85522
License Number StateND

VIII. Authorized Official

Name: TIM EISSINGER
Title or Position: CEO
Credential:
Phone: 701-252-3850