Provider Demographics
NPI:1215570692
Name:KOINONIA COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:KOINONIA COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ICF
Authorized Official - Prefix:
Authorized Official - First Name:MARILINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-588-8777
Mailing Address - Street 1:6161 OAK TREE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2581
Mailing Address - Country:US
Mailing Address - Phone:216-588-8777
Mailing Address - Fax:216-588-5670
Practice Address - Street 1:6809 SMITH RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-2681
Practice Address - Country:US
Practice Address - Phone:216-362-1740
Practice Address - Fax:216-362-6227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOINONIA COMMUNITY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities