Provider Demographics
NPI:1629842067
Name:KOA HEALTH DIGITAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:KOA HEALTH DIGITAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, DELIVERY & SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON-DRAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-818-7802
Mailing Address - Street 1:75 STATE ST FL 16
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1466
Mailing Address - Country:US
Mailing Address - Phone:617-619-8234
Mailing Address - Fax:
Practice Address - Street 1:75 STATE ST FL 16
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1466
Practice Address - Country:US
Practice Address - Phone:617-619-8234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty