Provider Demographics
NPI: | 1164294864 |
---|---|
Name: | ECUMEN SBC SARTELL PROPERTIES, LLC |
Entity Type: | Organization |
Organization Name: | ECUMEN SBC SARTELL PROPERTIES, LLC |
Other - Org Name: | SARTELL THERAPY SUITES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | COO/SVP OF OPERATION |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRETT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ANDERSON |
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: | 651-766-4310 |
Practice Address - Street 1: | 990 19TH ST S |
Practice Address - Street 2: | |
Practice Address - City: | SARTELL |
Practice Address - State: | MN |
Practice Address - Zip Code: | 56377-2596 |
Practice Address - Country: | US |
Practice Address - Phone: | 320-534-3000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ECUMEN SBC, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-10-25 |
Last Update Date: | 2023-12-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |