Healthcare Provider Details

I. General information

NPI: 1831115732
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 LONDON RD
DULUTH MN
55804-2220
US

IV. Provider business mailing address

3530 LEXINGTON AVE N
SHOREVIEW MN
55126-8166
US

V. Phone/Fax

Practice location:
  • Phone: 218-625-7849
  • Fax: 218-625-8274
Mailing address:
  • Phone: 218-625-7849
  • Fax: 651-766-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number367357
License Number StateMN

VIII. Authorized Official

Name: LORETTA LEWIS
Title or Position: SR. CREDENTIALING SPECIALISY
Credential:
Phone: 651-766-4375