Healthcare Provider Details

I. General information

NPI: 1336353101
Provider Name (Legal Business Name): KOINONIA FOSTER HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 AIRMOTIVE WAY
RENO NV
89502-3218
US

IV. Provider business mailing address

1050 BIBLE WAY
RENO NV
89502
US

V. Phone/Fax

Practice location:
  • Phone: 775-826-1113
  • Fax: 775-826-0248
Mailing address:
  • Phone: 775-826-1113
  • Fax: 775-826-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNV

VIII. Authorized Official

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