Healthcare Provider Details

I. General information

NPI: 1578602884
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 04/30/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5379 383RD ST
NORTH BRANCH MN
55056-4962
US

IV. Provider business mailing address

5379 383RD ST
NORTH BRANCH MN
55056-4962
US

V. Phone/Fax

Practice location:
  • Phone: 651-237-3000
  • Fax: 651-674-5745
Mailing address:
  • Phone: 651-237-3000
  • Fax: 651-674-5745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number331134
License Number StateMN

VIII. Authorized Official

Name: MS. SHELLEY L KENDRICK
Title or Position: CEO,PRESIDENT
Credential:
Phone: 651-766-4313