Provider Demographics
NPI:1669636379
Name:KOINONIA HEALTHCARE
Entity Type:Organization
Organization Name:KOINONIA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRI
Authorized Official - Middle Name:JILLA
Authorized Official - Last Name:LONGTCHI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:240-764-7217
Mailing Address - Street 1:5601 MARY A CT
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1650
Mailing Address - Country:US
Mailing Address - Phone:240-764-7217
Mailing Address - Fax:240-764-7218
Practice Address - Street 1:5601 MARY A CT
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1650
Practice Address - Country:US
Practice Address - Phone:240-764-7217
Practice Address - Fax:240-764-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2610251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health