Healthcare Provider Details

I. General information

NPI: 1104830546
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S DAVIS AVE
LITCHFIELD MN
55355-3431
US

IV. Provider business mailing address

3530 LEXINGTON AVE N
SHOREVIEW MN
55126-8166
US

V. Phone/Fax

Practice location:
  • Phone: 320-693-2472
  • Fax: 320-693-2242
Mailing address:
  • Phone: 651-766-4300
  • Fax: 651-766-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number356845
License Number StateMN

VIII. Authorized Official

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