Healthcare Provider Details

I. General information

NPI: 1306188065
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28210 OLD TOWNE RD
CHISAGO CITY MN
55013-9556
US

IV. Provider business mailing address

3530 LEXINGTON AVE N
SHOREVIEW MN
55126-8166
US

V. Phone/Fax

Practice location:
  • Phone: 651-257-7337
  • Fax: 651-257-0579
Mailing address:
  • Phone: 651-766-4300
  • Fax: 651-766-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number360572
License Number StateMN

VIII. Authorized Official

Name: DENNIS JOHNSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 651-766-4300