NPIMap

Organization Active NPI

Eventide

  • Assisted Living Facility
  • Moorhead, MN
National Provider Identifier
1487705653
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
332819 Issued in MN
Legal business name
EVENTIDE
Practice address
1405 7TH St S
Moorhead, MN 56560-3444
Phone
(218) 233-7508
Fax
(218) 233-3602
NPI assigned
Jan 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mr. Wade E Stubson
Title
Cfo
Phone
(218) 291-2216

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 332819 MN Primary
Skilled Nursing Facility 314000000X 00072 MN

Addresses

Primary practice location

1405 7TH St S
Moorhead, MN 56560-3444

Mailing address

1405 7TH St S
Moorhead, MN 56560-3444
Phone (218) 233-7508

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060505000953 MN Part A Provider - Skilled Nursing Facility 7810908712 Practice locations: Moorhead, MN

Skilled nursing facility certification: CCN 245461

Legal name
EVENTIDE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1987
Last certification
Apr 10, 2024
Beds
145
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Eventide
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1953 in MN
Enrollment address
1405 7TH St S
Moorhead, MN 56560-3444
Nursing home name
EVENTIDE LUTHERAN HOME

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Eventide Lutheran HomeCCN 245461
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
145112.6 residents per day on average
Penalties (3 years)
2Fines totaling $24,128

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Eventide4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

125 13th Ave W
West Fargo, ND 58078
Phone (701) 478-6000

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Kayla Kelly Individual Operational/Managerial Control Nov 26, 2023
Jon M Riewer Individual Corporate OfficerPresident Oct 31, 2003
Karla Swenson Individual Corporate Director Dec 15, 2022
Michael L Sand Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Mar 21, 2025
Eric Schafer Individual Corporate Director Oct 10, 2024
Darin G Ohe Individual Operational/Managerial Control Dec 18, 2018
Robert J Bye Individual Corporate OfficerChair Dec 15, 2022
Corporate Director Dec 15, 2022
Blue Stone Therapy Inc Organization, Urbandale, IA Corporation, Medical provider/supplier, For-profit Operational/Managerial Control Nov 1, 2020
Adp of the SNF Aug 29, 2025
Peter J Seljevold Individual Corporate Director Oct 1, 2009
Brandon Lunak Individual Corporate OfficerTreasurer Mar 1, 2026
Corporate Director Dec 15, 2022
Individual Adp of the SNF Nov 1, 2020
Brittni Berg Individual Operational/Managerial Control Apr 25, 2022
Tyler Fischbach Individual Corporate Director Dec 15, 2022
Kara Oakes Individual Operational/Managerial Control Mar 17, 2024
Jodee Bock Individual Corporate Director Dec 15, 2022
Patrick Gulbranson Individual Corporate Director Dec 15, 2022
Jim Hager Individual Operational/Managerial Control Dec 13, 2022
Terry Brandt Individual Corporate Director Dec 15, 2022
Emily Kollar Individual Operational/Managerial Control May 14, 2019
Adp of the SNF Mar 21, 2025
Kelsey Anderson Individual Operational/Managerial Control Jan 10, 2021
Individual Adp of the SNF Nov 1, 2020
Judith Lee Individual Corporate Director Dec 15, 2022
Kaley Harms Individual Operational/Managerial Control Nov 28, 2018
Cindy Larson-Casselton Individual Corporate Director Dec 15, 2022
Vikki Johnson Individual Corporate OfficerSecretary Dec 1, 2023
Corporate Director Dec 15, 2022

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 13

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Eventide Lincoln Care CenterLincoln, NE, CCN 285057 Skilled nursing facility Operational/Managerial Control Nov 20, 2024
Eventide HeartlandDevils Lake, ND, CCN 355069 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2014
Eventide CreteCrete, NE, CCN 285283 Skilled nursing facility Operational/Managerial Control Nov 21, 2024
Sheyenne Crossings Care Center/TcuWest Fargo, ND, CCN 355124 Skilled nursing facility 5% Or Greater Direct Ownership Interest Nov 18, 2009
Eventide JamestownJamestown, ND, CCN 355078 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 28, 2010
Eventide WilliamsburgLincoln, NE, CCN 285288 Skilled nursing facility Operational/Managerial Control Dec 18, 2024
Eventide FargoFargo, ND, CCN 355127 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 10, 2013
Eventide Prairie Commons Care CenterGrand Island, NE, CCN 285307 Skilled nursing facility Operational/Managerial Control Dec 19, 2024
Eventide Home Health CareLincoln, NE, CCN 287002 Home health agency Operational/Managerial Control (100%) Oct 10, 2024
Ethos Home HealthFargo, ND, CCN 357302 Home health agency Operational/Managerial Control Jun 30, 2018
Eventide HospiceLincoln, NE, CCN 281502 Hospice Operational/Managerial Control (100%) Oct 10, 2024
Ethos HospiceFargo, ND, CCN 351517 Hospice Operational/Managerial Control Jun 30, 2018
Tabitha Hospice-a Collaboration With ImmanuelOmaha, NE, CCN 281556 Hospice 5% Or Greater Indirect Ownership Interest Oct 10, 2024

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

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": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1487705653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 7TH ST S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565603444",
            "telephone_number": "218-233-7508",
            "fax_number": "218-233-3602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 7TH ST S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565603444",
            "telephone_number": "218-233-7508",
            "fax_number": "218-233-3602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVENTIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "STUBSON",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-291-2216",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "332819",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "00072",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

Verify at the official NPI Registry.