Healthcare Provider Details

I. General information

NPI: 1588871982
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N ARMSTRONG AVE
LITCHFIELD MN
55355-2272
US

IV. Provider business mailing address

3530 LEXINGTON AVE N
SHOREVIEW MN
55126-8164
US

V. Phone/Fax

Practice location:
  • Phone: 320-693-2430
  • Fax:
Mailing address:
  • Phone: 651-766-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number10429461ADC
License Number StateMN

VIII. Authorized Official

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