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
125 13TH AVE W, WEST FARGO, ND 58078-3356
(701) 478-6000
(701) 478-6001
Mailing address
1405 7TH ST S, MOORHEAD, MN 56560-3444
(218) 233-7508
(218) 233-3602
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
11/18/2009
Last updated
04/11/2011
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