Healthcare Provider Details

I. General information

NPI: 1275305971
Provider Name (Legal Business Name): ECUMEN SBC ST. CLOUD PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MINNESOTA BLVD
SAINT CLOUD MN
56304-2436
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:
Mailing address:
  • Phone: 651-766-4300
  • Fax: 651-766-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY KENDRICK
Title or Position: CEO
Credential:
Phone: 651-766-4300