1407887953 NPI number — COKATO CHARITABLE TRUST

Table of content: (NPI 1407887953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407887953 NPI number — COKATO CHARITABLE TRUST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COKATO CHARITABLE TRUST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COKATO MANOR HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407887953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
182 SUNSET AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55321-9620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-286-2158
Provider Business Mailing Address Fax Number:
320-286-2307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 COKATO ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55321-9404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-286-3049
Provider Business Practice Location Address Fax Number:
320-286-2307
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROICH
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/ADMINISTRATOR
Authorized Official Telephone Number:
320-286-2158

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  03746 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5900013 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 030802014 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 249075700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5Z74C0 . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 167905 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 60-12085 . This is a "IV THERAPY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 30437 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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