Healthcare Provider Details

I. General information

NPI: 1285584060
Provider Name (Legal Business Name): ECUMEN SBC ST. CLOUD PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 MINNESOTA BLVD
SAINT CLOUD MN
56304-2435
US

IV. Provider business mailing address

3530 LEXINGTON AVE N
SHOREVIEW MN
55126-8166
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-0010
  • Fax: 320-203-0952
Mailing address:
  • Phone: 651-766-4300
  • Fax: 651-766-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS HARRISON
Title or Position: CFO
Credential:
Phone: 651-766-4300