Provider Demographics
NPI:1023308749
Name:COKATO CHARITABLE TRUST
Entity type:Organization
Organization Name:COKATO CHARITABLE TRUST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STRATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-286-2158
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:320-286-5729
Practice Address - Street 1:600 3RD ST SE
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-9402
Practice Address - Country:US
Practice Address - Phone:320-286-3049
Practice Address - Fax:320-286-2307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COKATO CHARITABLE TRUST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHFID 26004253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHFID26004Medicaid