Provider Demographics
NPI:1467995738
Name:KOINONIA FOSTER HOMES, INC.
Entity Type:Organization
Organization Name:KOINONIA FOSTER HOMES, INC.
Other - Org Name:KOINONIA FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:SICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSY
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:916-307-5039
Practice Address - Street 1:41689 ENTERPRISE CIR N STE 120
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5630
Practice Address - Country:US
Practice Address - Phone:951-587-4165
Practice Address - Fax:951-587-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health