1396966123 NPI number — KOINONIA FOSTER HOMES INC

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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".




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