| Koinonia Inn | |
|
4841 Auto Center Way Ste 101 Bremerton WA 98312-4388 | |
| (360) 373-1529 | |
| (360) 373-4051 |
| Full Name | Koinonia Inn |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 4841 Auto Center Way Ste 101, Bremerton, Washington |
| Authorized Official Name and Position | Ondrea Mccourry (EXECUTIVE ASSISTANT) |
| Authorized Official Contact | 3603731529 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Koinonia Inn 4841 Auto Center Way Ste 101 Bremerton WA 98312-4388 Ph: (360) 373-1529 | Koinonia Inn 4841 Auto Center Way Ste 101 Bremerton WA 98312-4388 Ph: (360) 373-1529 |
| NPI Number | 1538282272 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 06/25/2020 |
| Certification Date | 06/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538282272 | NPI | - | NPPES |
| 1067521 | Medicaid | WA | |
| 1990365 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 18027300 (Washington) | Primary |
| 251B00000X | Case Management | (* (Not Available)) | Secondary |
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