Organization
ECUMEN
Active
Other names
Country Neighbors, Lake Crystal
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN R ROBERTS (CEO)
(651) 766-4300
Entity
Organization
Contact information
Practice address
511 W BLUE EARTH ST, LAKE CRYSTAL, MN 56055-9401
(507) 726-6537
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
335147
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A113473600
UMPI
—
Enumeration date
05/09/2007
Last updated
08/22/2020
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