Healthcare Provider Details

I. General information

NPI: 1346466083
Provider Name (Legal Business Name): ECUMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVER STREET
OSCEOLA WI
54020-3024
US

IV. Provider business mailing address

3530 LEXINGTON AVE N
SHOREVIEW MN
55126-8164
US

V. Phone/Fax

Practice location:
  • Phone: 715-294-5641
  • Fax: 715-294-5785
Mailing address:
  • Phone: 651-766-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2329
License Number StateWI

VIII. Authorized Official

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