Provider Demographics
NPI:1578602884
Name:ECUMEN
Entity Type:Organization
Organization Name:ECUMEN
Other - Org Name:ECUMEN NORTH BRANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO,PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-766-4313
Mailing Address - Street 1:5379 383RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-4962
Mailing Address - Country:US
Mailing Address - Phone:651-237-3000
Mailing Address - Fax:651-674-5745
Practice Address - Street 1:5379 383RD ST
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-4962
Practice Address - Country:US
Practice Address - Phone:651-237-3000
Practice Address - Fax:651-674-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331134314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN533840900Medicaid
MN7122648OtherMEDICA
MN8812GROtherBLUE PLUS
MNNH0347OtherUCARE
MN7122648OtherMEDICA