Organization
EVENTIDE
Active
Other names
Eventide Lutheran Home for the Aged
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MINDI RENAE BAKER NHA (ADMINISTRATOR)
(712) 263-3114
Entity
Organization
Contact information
Practice address
114 S 20TH ST, DENISON, IA 51442-2251
(712) 263-3114
(712) 263-8819
Mailing address
114 S 20TH ST, DENISON, IA 51442-2251
(712) 263-3114
(712) 263-8819
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
0890475
IA
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0801217
—
IA
05
—
0890475
—
IA
Enumeration date
10/05/2005
Last updated
10/17/2013
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