Provider Demographics
NPI:1639126790
Name:ECUMEN
Entity Type:Organization
Organization Name:ECUMEN
Other - Org Name:ECUMEN SCENIC SHORES
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:
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-766-4366
Mailing Address - Street 1:402 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1267
Mailing Address - Country:US
Mailing Address - Phone:218-834-8374
Mailing Address - Fax:218-834-8439
Practice Address - Street 1:402 13TH AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1267
Practice Address - Country:US
Practice Address - Phone:218-834-8374
Practice Address - Fax:218-834-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331615314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0Z72LAOtherBCBS OF MINNESOTA
MN140001OtherFIRST PLAN OF MINNESOTA
MN048540300Medicaid
MN0Z72LAOtherBCBS OF MINNESOTA