Provider Demographics
NPI:1336353101
Name:KOINONIA FOSTER HOMES, INC.
Entity Type:Organization
Organization Name:KOINONIA FOSTER HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC EX DIRECTOR CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARGUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:775-826-1113
Mailing Address - Street 1:1050 BIBLE WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-826-1113
Mailing Address - Fax:775-826-0248
Practice Address - Street 1:1355 AIRMOTIVE WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3218
Practice Address - Country:US
Practice Address - Phone:775-826-1113
Practice Address - Fax:775-826-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253J00000X
NV322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507962Medicaid