Provider Demographics
NPI:1902436744
Name:KOINONIA FOSTER HOMES, INC.
Entity Type:Organization
Organization Name:KOINONIA FOSTER HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:SICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-926-3916
Mailing Address - Street 1:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-1403
Mailing Address - Country:US
Mailing Address - Phone:916-652-5802
Mailing Address - Fax:
Practice Address - Street 1:1881 BUSINESS CENTER DR STE 10
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3465
Practice Address - Country:US
Practice Address - Phone:909-890-2381
Practice Address - Fax:909-890-0580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOINONIA FOSTER HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health