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General NPI Number Information
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NPI Number | 1407887953
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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 | 07/05/2006
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 511 COKATO ST NW
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City | COKATO
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State | MN
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Zip | 55321-9404
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Country | US
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Telephone | 320-286-3049
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Fax | 320-286-2307
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Provider Business Mailing Address
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Address Line | 182 SUNSET AVE NW
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City | COKATO
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State | MN
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Zip | 55321-9620
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Country | US
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Telephone | 320-286-2158
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Fax | 320-286-2307
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | JAMES BROICH
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 03746
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License Number State | MN
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