Healthcare Provider Details

I. General information

NPI: 1811101884
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 SAINT PAUL RD
OWATONNA MN
55060-2455
US

IV. Provider business mailing address

3530 LEXINGTON AVE N
SHOREVIEW MN
55126-8164
US

V. Phone/Fax

Practice location:
  • Phone: 507-446-0611
  • 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 Number332127
License Number StateMN

VIII. Authorized Official

Name: KATHRYN R ROBERTS
Title or Position: CEO
Credential:
Phone: 651-766-4300