MEDICARE: AKRON ASHTABULA CLEVE BAPTIST ASSN CAMP KOINONIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	385HR2050X	Respite Care Camp

General Provider Information

NPI Number	:	1316810427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKRON ASHTABULA CLEVE BAPTIST ASSN CAMP KOINONIA

Provider Business Mailing Address
First Line	:	6810 CORK COLD SPRINGS RD
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9346
Country	:	US
Telephone Number	:	440-466-1278
Fax Number	:

Provider Business Practice Location Address
First Line	:	6810 CORK COLD SPRINGS RD
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9346
Country	:	US
Telephone Number	:	440-466-1278
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST/DISABILITY S
Name	:	ANGELINA GILL
Credential	:	OTR/L
Telephone Number	:	440-812-1787

Provider Enumeration Date	:	09/25/2025
Last Update Date	:	12/03/2025

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