Healthcare Provider Details

I. General information

NPI: 1235585084
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 LARK ST
ALEXANDRIA MN
56308-2219
US

IV. Provider business mailing address

1020 LARK ST
ALEXANDRIA MN
56308-2219
US

V. Phone/Fax

Practice location:
  • Phone: 320-759-5052
  • Fax: 320-759-6327
Mailing address:
  • Phone: 320-759-5052
  • Fax: 320-759-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY L KENDRICK
Title or Position: CEO
Credential:
Phone: 651-766-4300