Provider Demographics
NPI:1467997403
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:
Practice Address - Street 1:1225 W 190TH ST STE 255
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4342
Practice Address - Country:US
Practice Address - Phone:310-217-0930
Practice Address - Fax:310-217-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health