Healthcare Provider Details

I. General information

NPI: 1124234554
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 EL DORADO ST
OWATONNA MN
55060
US

IV. Provider business mailing address

3530 LEXINGTON AVE N
SHOREVIEW MN
55126-8164
US

V. Phone/Fax

Practice location:
  • Phone: 507-446-8334
  • Fax:
Mailing address:
  • Phone: 651-766-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number334372
License Number StateMN

VIII. Authorized Official

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