Healthcare Provider Details

I. General information

NPI: 1487712493
Provider Name (Legal Business Name): COOK COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 5TH AVE W
GRAND MARAIS MN
55604-3017
US

IV. Provider business mailing address

515 5TH AVE W
GRAND MARAIS MN
55604-3017
US

V. Phone/Fax

Practice location:
  • Phone: 218-387-3040
  • Fax:
Mailing address:
  • Phone: 218-387-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number330902
License Number StateMN

VIII. Authorized Official

Name: KIMBER WRAALSTAD
Title or Position: ADMINISTRATOR
Credential:
Phone: 218-387-3260