MEDICARE: ECUMEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	332127	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811101884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECUMEN

Provider Business Mailing Address
First Line	:	3530 LEXINGTON AVE N
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-8164
Country	:	US
Telephone Number	:	651-766-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 SAINT PAUL RD
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-2455
Country	:	US
Telephone Number	:	507-446-0611
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KATHRYN R ROBERTS
Credential	:
Telephone Number	:	651-766-4300

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/29/2012

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Directions to “ECUMEN ” Practice Location

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