NPIMap

Organization Active NPI

Anne Carlsen Center

  • Intellectual Disabilities Intermediate Care Facility
  • Jamestown, ND
National Provider Identifier
1386829190
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
ANNE CARLSEN CENTER
Practice address
605 3Rd St NW
Jamestown, ND 58401-2965
Phone
(701) 252-3850
NPI assigned
Dec 31, 2007
Last updated
Feb 18, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
ANNE CARLSEN CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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

Authorized official

Name
Tim Eissinger
Title
Ceo
Phone
(701) 952-5187

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X ND Primary

Addresses

Primary practice location

605 3Rd St NW
Jamestown, ND 58401-2965

Mailing address

701 3Rd St NW
Jamestown, ND 58401-2963
Phone (701) 252-3850

Other identifiers 1

IdentifierTypeStateIssuer
30875MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386829190. Details of each certification follow.

  • CCN 35G078 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 35G078

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Anne Carlsen Center - Fall (605)
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 30, 2004
Last certification
Nov 5, 2025
Beds
8
Ownership / control type
Private (non-profit)
Facility address
605 3rd St NW
Jamestown, ND 58401

National Provider Directory

National Provider Directory
Tax ID family
Anne Carlsen Center for Children10 organizations share this tax ID, including this one
Part of
Anne Carlsen Center for Children

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1386829190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 3RD ST NW",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584012963",
            "telephone_number": "701-252-3850",
            "fax_number": "701-952-5154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 3RD ST NW",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584012965",
            "telephone_number": "701-252-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNE CARLSEN CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANNE CARLSEN CENTER",
        "enumeration_date": "2007-12-31",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A",
        "authorized_official_last_name": "EISSINGER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-952-5187"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30875",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, ND

Sources for this page

Verify at the official NPI Registry.