Healthcare Provider Details

I. General information

NPI: 1154455343
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
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: 320-762-5316
  • Fax:
Mailing address:
  • Phone: 320-762-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number329434
License Number StateMN

VIII. Authorized Official

Name: KATHRYN R ROBERTS
Title or Position: CEO
Credential:
Phone: 651-766-4300