Provider Demographics
NPI:1831115732
Name:ECUMEN
Entity Type:Organization
Organization Name:ECUMEN
Other - Org Name:ECUMEN HOME CARE - LAKESHORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MORSHED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-625-7848
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:218-625-7849
Mailing Address - Fax:651-766-4481
Practice Address - Street 1:4000 LONDON RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2220
Practice Address - Country:US
Practice Address - Phone:218-625-7849
Practice Address - Fax:218-625-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN367357251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN958553200Medicaid
MN958553200Medicaid