Healthcare Provider Details

I. General information

NPI: 1871165142
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 MADISON AVE
DETROIT LAKES MN
56501-4542
US

IV. Provider business mailing address

3530 LEXINGTON AVE N
SHOREVIEW MN
55126-8166
US

V. Phone/Fax

Practice location:
  • Phone: 651-714-0200
  • Fax: 651-714-0201
Mailing address:
  • Phone: 651-766-4375
  • Fax: 651-766-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT BJERKEVEDT
Title or Position: VP OF FINANCE
Credential:
Phone: 651-766-4300