Healthcare Provider Details

I. General information

NPI: 1720223886
Provider Name (Legal Business Name): KOINONIA PARTNERS UNLIMITED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34000 PETTIBONE RD
SOLON OH
44139-5012
US

IV. Provider business mailing address

6161 OAK TREE BLVD SUITE #400
INDEPENDENCE OH
44131-2516
US

V. Phone/Fax

Practice location:
  • Phone: 440-349-3059
  • Fax:
Mailing address:
  • Phone: 216-588-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DIANE BEASTROM
Title or Position: CEO
Credential:
Phone: 216-588-8777