Douglas Place Treatment Center LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

1071339 Issued in MN

Legal business name

DOUGLAS PLACE TREATMENT CENTER LLC

Doing business as

Eosis Northern Plains

Practice address

1111 Gateway Dr NE
East Grand Forks, MN 56721-2620

Phone

(612) 326-7600

NPI assigned

Dec 12, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lewis P Zeidner, PHD

Title

Ceo

Phone

(763) 245-8278

Specialties & licenses 1

Addresses

Other names 1

• Eosis Northern Plains Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1306277645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 MAIN ST",
            "address_2": "STE 230",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551123271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 GATEWAY DR NE",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567212620",
            "telephone_number": "612-326-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS PLACE TREATMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-12",
        "last_updated": "2025-02-21",
        "status": "A",
        "authorized_official_last_name": "ZEIDNER",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-245-8278",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "1071339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eosis Northern Plains",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Destin Ross Coles, O.D.
• Gena Cornelius
• Farah Mohamed Dahir
• Demers Dental
• Dental GT
• Kathleen Rand Dunn, RN
• East Grand Forks Dental Care
• Lindsey Marie Ebertowski, PT
• Edgewood Vista
• Terra Nicole Edwards, APRN, PMHNP-BC

• Substance Abuse Rehabilitation Facility in East Grand Forks, MN
• Providers in East Grand Forks, MN by specialty
• Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.