Organization
EVENTIDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WADE E STUBSON (CFO)
(218) 291-2216
Entity
Organization
Contact information
Practice address
1405 7TH ST S, MOORHEAD, MN 56560-3444
(218) 233-7508
(218) 233-3602
Mailing address
1405 7TH ST S, MOORHEAD, MN 56560-3444
(218) 233-7508
(218) 233-3602
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
332819
MN
314000000X
Skilled Nursing Facility
00072
MN
Other
Enumeration date
01/15/2007
Last updated
09/11/2025
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