MEDICARE: ECUMEN SBC ST. CLOUD PROPERTIES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356291975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECUMEN SBC ST. CLOUD PROPERTIES, LLC

Provider Business Mailing Address
First Line	:	3530 LEXINGTON AVE N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55126-8166
Country	:	US
Telephone Number	:	651-766-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1980 15TH AVE SE
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56304-2380
Country	:	US
Telephone Number	:	320-252-0010
Fax Number	:	320-200-3261

Authorized Official
Title or Position	:	CFO
Name	:	DOUGLAS HARRISON
Credential	:
Telephone Number	:	651-766-4300

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/03/2026

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