# EVENTIDE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942538608
- **Authorized official:** MR. WADE E STUBSON (CFO)
- **Authorized official phone:** (218) 291-2216

## Contact information

- **Practice address:** 125 13TH AVE W, WEST FARGO, ND 58078-3356
- **Practice address phone:** (701) 478-6000
- **Practice address fax:** (701) 478-6001
- **Mailing address:** 1405 7TH ST S, MOORHEAD, MN 56560-3444
- **Mailing address phone:** (218) 233-7508
- **Mailing address fax:** (218) 233-3602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/18/2009
- **Last updated:** 04/11/2011