Provider Demographics
NPI:1528044971
Name:THE EVENTIDE HOME
Entity type:Organization
Organization Name:THE EVENTIDE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:UEBELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-772-5743
Mailing Address - Street 1:81 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833
Mailing Address - Country:US
Mailing Address - Phone:603-772-5743
Mailing Address - Fax:603-778-0241
Practice Address - Street 1:81 HIGH ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2908
Practice Address - Country:US
Practice Address - Phone:603-772-5743
Practice Address - Fax:603-778-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH730310400000X
NH00283313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99750096Medicaid