| NPI | 1164809562 |
|---|---|
| Doing Business As | EVENTIDE FARGO |
| Entity Type | Organization |
| Authorized Contact | WADE E STUBSON CFO 218-291-2216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2016-08-10 |