| NPI | 1619536976 |
|---|---|
| Doing Business As | EVENTIDE LAKE COUNTRY MANOR BASIC CARE |
| Entity Type | Organization |
| Authorized Contact | JON RIEWER President & CEO 218-291-2201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |