Provider Demographics
NPI:1972665149
Name:KOINONIA HOMES, INC.
Entity Type:Organization
Organization Name:KOINONIA HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:REYNOLDS
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 STE 400
Mailing Address - Street 2:
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 1:10000 GRANGER RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3102
Practice Address - Country:US
Practice Address - Phone:216-662-8789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251C00000X, 251J00000X, 320600000X, 347C00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251J00000XAgenciesNursing Care
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0900949Medicaid