| Organization Name: | KOINONIA COMMUNITY SERVICES LLC |
| NPI Number: | 1790939858 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE BEASTROM (CEO) |
| Mailing Address: | 6161 Oak Tree Blvd Suite #400 Independence |
| State: | OH US |
| Postal Code: | 441312516 |
| Phone Number: | 2165888777 |
| Fax Number: | 2165885670 |
| NPI Enumeration Date: | 11/15/2008 |
| NPI Last Update Date: | 11/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Voluntary or Charitable |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |