Healthcare Provider Details

I. General information

NPI: 1245725464
Provider Name (Legal Business Name): KOINONIA FOSTER HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 TAYLOR RD
LOOMIS CA
95650
US

IV. Provider business mailing address

PO BOX 1403
LOOMIS CA
95650-1403
US

V. Phone/Fax

Practice location:
  • Phone: 946-652-5814
  • Fax:
Mailing address:
  • Phone: 916-652-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number097005992
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number097005992
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA MILLER
Title or Position: MENTAL HEALTH SUPERVISOR
Credential: LCSW
Phone: 916-652-5814