Provider Demographics
NPI:1598461790
Name:KOINONIA, INC
Entity Type:Organization
Organization Name:KOINONIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-213-7800
Mailing Address - Street 1:278 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2500
Mailing Address - Country:US
Mailing Address - Phone:540-213-7800
Mailing Address - Fax:540-213-7801
Practice Address - Street 1:278 LEE HWY
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2500
Practice Address - Country:US
Practice Address - Phone:540-213-7800
Practice Address - Fax:540-213-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care