=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285584060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ECUMEN SBC ST. CLOUD PROPERTIES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2026
-----------------------------------------------------
Last Update Date | 02/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1340 MINNESOTA BLVD
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56304-2435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-252-0010
-----------------------------------------------------
Fax | 320-203-0952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3530 LEXINGTON AVE N
-----------------------------------------------------
City | SHOREVIEW
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55126-8166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-766-4300
-----------------------------------------------------
Fax | 651-766-4479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | DOUGLAS HARRISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-766-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311500000X
-----------------------------------------------------
Taxonomy Name | Alzheimer Center (Dementia Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------