Provider Demographics
NPI:1104830546
Name:ECUMEN
Entity Type:Organization
Organization Name:ECUMEN
Other - Org Name:EMMANUEL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-766-4300
Mailing Address - Street 1:3530 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8166
Mailing Address - Country:US
Mailing Address - Phone:651-766-4300
Mailing Address - Fax:651-766-4479
Practice Address - Street 1:600 S DAVIS AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-3431
Practice Address - Country:US
Practice Address - Phone:320-693-2472
Practice Address - Fax:320-693-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN356845314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
03080201701OtherPRIME WEST
MN8766EMOtherBLUE CROSS BLUE SHIELD
31895OtherHEALTH PARTNERS
7122534OtherMEDICA
MN134543500Medicaid
MNNH0033OtherUCARE
31895OtherHEALTH PARTNERS