Basic Information
| Provider Information | |||||||||
| NPI: | 1720523764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KOINONIA FOSTER HOMES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1403 | ||||||||
| Address2: | |||||||||
| City: | LOOMIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956501403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166525802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 38345 30TH ST E | ||||||||
| Address2: | SUITE A-1 | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935504980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612738122 | ||||||||
| FaxNumber: | 6612736199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2016 | ||||||||
| LastUpdateDate: | 12/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | SPANN | ||||||||
| AuthorizedOfficialFirstName: | DEENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9166525802 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.