Healthcare Provider Details

I. General information

NPI: 1982147294
Provider Name (Legal Business Name): KOINONIA FOSTER HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20432 W VALLEY BLVD STE C & D
TEHACHAPI CA
93561-8664
US

IV. Provider business mailing address

PO BOX 1403
LOOMIS CA
95650-1403
US

V. Phone/Fax

Practice location:
  • Phone: 661-823-9738
  • Fax:
Mailing address:
  • Phone: 916-652-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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