Organization
ECUMEN
Active
Other names
EMMANUEL NURSING HOME
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS HARRISON (CFO)
(651) 766-4300
Entity
Organization
Contact information
Practice address
1415 MADISON AVE, DETROIT LAKES, MN 56501-4542
(218) 847-4486
(218) 847-4488
Mailing address
3530 LEXINGTON AVE N, SHOREVIEW, MN 55126-8166
(651) 766-4300
(651) 766-4479
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30323
NORTH DAKOTA MA
MN
01
—
7122692
MEDICA INSURANCE COMPANY
MN
05
—
726040700
—
MN
01
—
8613EM
BLUE CROSS BLUE SHIELD
MN
Enumeration date
01/15/2007
Last updated
04/22/2026
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