Provider Demographics
NPI:1225192073
Name:COOK COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:COOK COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WRAALSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-387-3260
Mailing Address - Street 1:515 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-3017
Mailing Address - Country:US
Mailing Address - Phone:218-387-3040
Mailing Address - Fax:
Practice Address - Street 1:515 5TH AVE W
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-3017
Practice Address - Country:US
Practice Address - Phone:218-387-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331910314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3657451000Medicaid
MN1658HCOOtherBCBC OF MN
MN3657451000Medicaid
MN245384Medicare Oscar/Certification