Organization
EVENTIDE FARGO LLC
Active
Other names
Eventide Fargo
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WADE E STUBSON (CFO)
(218) 291-2216
Entity
Organization
Contact information
Practice address
3225 51ST ST S, FARGO, ND 58104-7180
(218) 291-2230
Mailing address
2405 8TH ST S, SUITE A, MOORHEAD, MN 56560-4224
(218) 291-2230
(218) 477-3250
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467362
—
ND
Enumeration date
05/05/2015
Last updated
08/10/2016
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