NPIMap

Organization Active NPI

Eventide

  • Skilled Nursing Facility
  • Denison, IA
National Provider Identifier
1417944265
Registry record updated Oct 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EVENTIDE
Practice address
114 S 20TH St
Denison, IA 51442-2251
Phone
(712) 263-3114
Fax
(712) 263-8819
NPI assigned
Oct 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Mindi Renae Baker, NHA
Title
Administrator
Phone
(712) 263-3114

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Custodial Care Facility 311Z00000X 0890475 IA
Nursing Facility/Intermediate Care Facility 313M00000X
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

114 S 20TH St
Denison, IA 51442-2251

Mailing address

114 S 20TH St
Denison, IA 51442-2251
Phone (712) 263-3114

Other identifiers 2

IdentifierTypeStateIssuer
0801217MedicaidIA
0890475MedicaidIA

Other names 1

  • Eventide Lutheran Home for the Aged Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031125000186 IA Part A Provider - Skilled Nursing Facility 5395649941 Practice locations: Denison, IA

Skilled nursing facility certification: CCN 165532

Legal name
EVENTIDE
Doing business as
EVENTIDE LUTHERAN HOME FOR THE AGED
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 2004
Last certification
Oct 31, 2024
Beds
84
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 26, 1961 in IA
Enrollment address
114 S 20TH St
Denison, IA 51442-2251
Nursing home name
GRACEWELL, AN EVENTIDE COMMUNITY

Care Compare: Nursing home

Medicare Care Compare
Listed as
Gracewell, An Eventide CommunityCCN 165532
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8473.4 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0385630Eventide Lutheran Home114 South 20TH Street, Denison, IA 51442Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mark Spiegel Individual Corporate Director Aug 15, 2017
Todd Schultz Individual Corporate Director Aug 15, 2005
Tonya Eller Individual Corporate DirectorBoard Member Aug 15, 2014
Danyl Jepsen Individual Corporate Director Aug 15, 2016
Mindi R Baker Individual Corporate OfficerCeo / Authorized Official Jan 30, 2017
W-2 Managing EmployeeAdministrator Apr 28, 2005
Amy M Schultz Individual Corporate OfficerAdministrator-Delegated Official Jan 30, 2018
W-2 Managing EmployeeNursing Home Admin & Delegated O Jan 30, 2018
Mark Gray Individual Corporate Director Dec 9, 2003

Practitioners & affiliated clinicians

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381968000000",
    "number": "1417944265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 S 20TH ST",
            "city": "DENISON",
            "state": "IA",
            "postal_code": "514422251",
            "telephone_number": "712-263-3114",
            "fax_number": "712-263-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 S 20TH ST",
            "city": "DENISON",
            "state": "IA",
            "postal_code": "514422251",
            "telephone_number": "712-263-3114",
            "fax_number": "712-263-8819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVENTIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2013-10-17",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "MINDI",
        "authorized_official_middle_name": "RENAE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "712-263-3114",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "IA",
            "license": "0890475",
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0801217",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0890475",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eventide Lutheran Home for the Aged",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denison, IA

Sources for this page

Verify at the official NPI Registry.