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General NPI Number Information
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NPI Number | 1104830546
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Entity Type | Organization
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Legal Business Name | ECUMEN
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 600 S DAVIS AVE
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City | LITCHFIELD
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State | MN
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Zip | 55355-3431
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Country | US
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Telephone | 320-693-2472
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Fax | 320-693-2242
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Provider Business Mailing Address
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Address Line | 3530 LEXINGTON AVE N
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City | SHOREVIEW
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State | MN
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Zip | 55126-8166
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Country | US
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Telephone | 651-766-4300
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Fax | 651-766-4479
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | MR. SCOTT R RIDDLE
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Credential |
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Telephone | 651-766-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 356845
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License Number State | MN
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