Provider Demographics
NPI:1376682781
Name:ECUMEN
Entity Type:Organization
Organization Name:ECUMEN
Other - Org Name:ECUMEN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENDRICK
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:651-766-4481
Practice Address - Street 1:3530 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8166
Practice Address - Country:US
Practice Address - Phone:651-714-0200
Practice Address - Fax:651-714-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN364084251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3Z03L1OtherBUE CROSS
MN5025445OtherMEDICA
MN80309255200OtherPRIME WEST
MN350027600Medicaid
MN3Z03L1OtherBUE CROSS