Organization
ECUMEN
Active
Other names
Centennial House of Apple Valley
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN R ROBERTS (CEO)
(651) 766-4300
Entity
Organization
Contact information
Practice address
14625 PENNOCK AVE, APPLE VALLEY, MN 55124-3502
(952) 891-2711
Mailing address
3530 LEXINGTON AVE N, SHOREVIEW, MN 55126-8164
(651) 766-4300
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
335383
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171671
UCARE
—
05
—
897917100
—
MN
Enumeration date
05/10/2007
Last updated
08/22/2020
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