1396966123 NPI number — KOINONIA FOSTER HOMES INC

Table of content: (NPI 1396966123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396966123 NPI number — KOINONIA FOSTER HOMES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOINONIA FOSTER HOMES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KOINONIA FAMILY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396966123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 BIBLE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-826-1113
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 AIRMOTIVE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-826-1113
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SICKLER
Authorized Official First Name:
TIFFANY
Authorized Official Middle Name:
DANIELLE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
916-652-5802

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100507963 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507964 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100509042 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".