Healthcare Provider Details

I. General information

NPI: 1720523764
Provider Name (Legal Business Name): KOINONIA FOSTER HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44811 DATE AVE STE B
LANCASTER CA
93534-3147
US

IV. Provider business mailing address

PO BOX 1403
LOOMIS CA
95650-1403
US

V. Phone/Fax

Practice location:
  • Phone: 661-273-8122
  • Fax: 661-273-6199
Mailing address:
  • Phone: 916-652-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JARED RADDIGAN
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY
Phone: 916-577-7982