Healthcare Provider Details

I. General information

NPI: 1407186158
Provider Name (Legal Business Name): ECUMEN PROPERTIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
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: 320-762-1567
  • Fax: 320-762-5316
Mailing address:
  • Phone: 320-762-1567
  • Fax: 320-762-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number339992
License Number StateMN

VIII. Authorized Official

Name: CAROL KVIDT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 320-762-1567