Provider Demographics
NPI:1639219272
Name:ECUMEN
Entity Type:Organization
Organization Name:ECUMEN
Other - Org Name:BAYSHORE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO,PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-766-4313
Mailing Address - Street 1:1601 SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2442
Mailing Address - Country:US
Mailing Address - Phone:218-727-8651
Mailing Address - Fax:218-727-1761
Practice Address - Street 1:1601 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2442
Practice Address - Country:US
Practice Address - Phone:218-727-8651
Practice Address - Fax:218-727-1761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1019527-1-RPH314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN228644100Medicaid
MN411768508OtherST MARY HOSPICE
MN245227Medicare ID - Type UnspecifiedMEDICARE