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General NPI Number Information
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NPI Number | 1104040211
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Entity Type | Organization
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Legal Business Name | COKATO CHARITABLE TRUST
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 180 SUNSET AVE NW
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City | COKATO
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State | MN
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Zip | 55321-9601
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Country | US
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Telephone | 320-286-3196
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Fax | 320-286-3163
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Provider Business Mailing Address
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Address Line | 180 SUNSET AVE NW
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City | COKATO
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State | MN
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Zip | 55321-9601
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Country | US
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Telephone | 320-286-3196
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Fax | 320-286-3163
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATHLEEN J KRATZ
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Credential |
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Telephone | 320-286-2158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | HFID 20830
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License Number State | MN
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