Provider Demographics
NPI:1891852299
Name:KOINONIA HOMES, INC
Entity Type:Organization
Organization Name:KOINONIA HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEASTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-588-8777
Mailing Address - Street 1:6161 OAK TREE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2516
Mailing Address - Country:US
Mailing Address - Phone:216-588-8777
Mailing Address - Fax:216-588-5670
Practice Address - Street 1:6161 OAK TREE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2516
Practice Address - Country:US
Practice Address - Phone:216-588-8777
Practice Address - Fax:216-588-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1800975OtherCONTRACT VENDOR NUMBER