Provider Demographics
NPI:1740022334
Name:KOINONIA FOSTER HOMES INC
Entity type:Organization
Organization Name:KOINONIA FOSTER HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:SICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-652-5802
Mailing Address - Street 1:41689 ENTERPRISE CIR N
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5630
Mailing Address - Country:US
Mailing Address - Phone:951-587-4165
Mailing Address - Fax:
Practice Address - Street 1:24135 HIBISCUS LN
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2716
Practice Address - Country:US
Practice Address - Phone:951-852-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty