Provider Demographics
NPI:1982147294
Name:KOINONIA FOSTER HOMES INC
Entity type:Organization
Organization Name:KOINONIA FOSTER HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-652-5802
Mailing Address - Street 1:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-1403
Mailing Address - Country:US
Mailing Address - Phone:916-652-5802
Mailing Address - Fax:
Practice Address - Street 1:20432 W VALLEY BLVD
Practice Address - Street 2:STE C & D
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8664
Practice Address - Country:US
Practice Address - Phone:661-823-9738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health