| Koinonia Homes For Teens | |
|
3580 Shallow Creek Road Loomis CA 95650-8813 | |
| (916) 652-0171 | |
| Not Available |
| Full Name | Koinonia Homes For Teens |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3580 Shallow Creek Road, Loomis, California |
| Authorized Official Name and Position | Bill Ryland (DIRECTOR) |
| Authorized Official Contact | 9166520171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Koinonia Homes For Teens Po Box 1403 Loomis CA 95650-1403 Ph: (916) 652-0171 | Koinonia Homes For Teens 3580 Shallow Creek Road Loomis CA 95650-8813 Ph: (916) 652-0171 |
| NPI Number | 1942768221 |
|---|---|
| Provider Enumeration Date | 03/06/2019 |
| Last Update Date | 03/16/2021 |
| Certification Date | 02/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942768221 | NPI | - | NPPES |
| 317000875 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 253J00000X | Foster Care Agency | (* (Not Available)) | Secondary |
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Koinonia Homes For Teens Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5980 Webb St, Loomis, CA 95650 Phone: 916-652-0171 Fax: 916-652-3979 |