Healthcare Provider Details

I. General information

NPI: 1922748516
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 MOUND AVE
MANKATO MN
56001-1626
US

IV. Provider business mailing address

718 MOUND AVE
MANKATO MN
56001-1626
US

V. Phone/Fax

Practice location:
  • Phone: 73-454-5765
  • Fax: 507-385-4212
Mailing address:
  • Phone: 651-766-4375
  • Fax: 651-766-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LORETTA LEWIS
Title or Position: SR. LICENSING SPECIALIST
Credential:
Phone: 651-766-4375