Healthcare Provider Details

I. General information

NPI: 1780184846
Provider Name (Legal Business Name): KOINONIA FOSTER HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 WEBB ST
LOOMIS CA
95650-7625
US

IV. Provider business mailing address

PO BOX 1403
LOOMIS CA
95650-1403
US

V. Phone/Fax

Practice location:
  • Phone: 916-652-0171
  • Fax: 916-652-3979
Mailing address:
  • Phone: 916-652-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0554.14
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number0554.14.01
License Number StateCA

VIII. Authorized Official

Name: MR. JARED RADDIGAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-599-7982