Provider Demographics
NPI:1164419057
Name:COKATO CHARITABLE TRUST
Entity Type:Organization
Organization Name:COKATO CHARITABLE TRUST
Other - Org Name:COKATO MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-286-3103
Mailing Address - Street 1:182 SUNSET AVE NW
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-9620
Mailing Address - Country:US
Mailing Address - Phone:320-286-2158
Mailing Address - Fax:320-286-2031
Practice Address - Street 1:182 SUNSET AVE NW
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-9620
Practice Address - Country:US
Practice Address - Phone:320-286-2158
Practice Address - Fax:320-286-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329785314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN423526600Medicaid
MN5Z74COOtherCMHH BCBS
MN7111807OtherCM MEDICA
MN9681COOtherCM BCBS
MN249075700Medicaid
MN040705008OtherCM PRIME WEST
MN167905OtherCMHH UCARE
MN5900013OtherCMHH MEDICA
MN030802014OtherCMHH PRIME WEST
MN30437OtherCMHH HEALTH PARTNERS
MN961043000Medicaid
MN030802014OtherCMHH PRIME WEST
MN249075700Medicaid