Healthcare Provider Details

I. General information

NPI: 1699482299
Provider Name (Legal Business Name): KOINONIA'S WAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18979 E 58TH AVE
DENVER CO
80249-8328
US

IV. Provider business mailing address

18978 E 58TH AVE
DENVER CO
80249-8331
US

V. Phone/Fax

Practice location:
  • Phone: 720-375-2016
  • Fax:
Mailing address:
  • Phone: 720-665-7265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIC PERRY
Title or Position: PRESIDENT
Credential:
Phone: 720-665-7265