Provider Demographics
NPI:1891433637
Name:KOINONIA BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:KOINONIA BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY & COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-588-8777
Mailing Address - Street 1:6161 OAK TREE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2581
Mailing Address - Country:US
Mailing Address - Phone:216-588-8777
Mailing Address - Fax:
Practice Address - Street 1:6161 OAK TREE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2581
Practice Address - Country:US
Practice Address - Phone:216-588-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOINONIA HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1407334824Medicaid