Provider Demographics
NPI:1104040211
Name:COKATO CHARITABLE TRUST
Entity Type:Organization
Organization Name:COKATO CHARITABLE TRUST
Other - Org Name:BROOKRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-286-2158
Mailing Address - Street 1:180 SUNSET AVE NW
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-9601
Mailing Address - Country:US
Mailing Address - Phone:320-286-3196
Mailing Address - Fax:320-286-3163
Practice Address - Street 1:180 SUNSET AVE NW
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-9601
Practice Address - Country:US
Practice Address - Phone:320-286-3196
Practice Address - Fax:320-286-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHFID 20830310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility