Healthcare Provider Details

I. General information

NPI: 1316810427
Provider Name (Legal Business Name): AKRON ASHTABULA CLEVE BAPTIST ASSN CAMP KOINONIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 CORK COLD SPRINGS RD
GENEVA OH
44041-9346
US

IV. Provider business mailing address

6810 CORK COLD SPRINGS RD
GENEVA OH
44041-9346
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-1278
  • Fax:
Mailing address:
  • Phone: 440-466-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: ANGELINA GILL
Title or Position: OCCUPATIONAL THERAPIST/DISABILITY S
Credential: OTR/L
Phone: 440-812-1787