Provider Demographics
NPI:1073568119
Name:ECUMEN
Entity Type:Organization
Organization Name:ECUMEN
Other - Org Name:LO SIMENSTAD NURSING CARE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:WISER
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:715-294-5642
Mailing Address - Street 1:301 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-3024
Mailing Address - Country:US
Mailing Address - Phone:715-294-5642
Mailing Address - Fax:715-294-5785
Practice Address - Street 1:301 RIVER ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-3024
Practice Address - Country:US
Practice Address - Phone:715-294-5642
Practice Address - Fax:715-294-5785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2329314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20195600Medicaid