KOINONIA COMMUNITY SERVICES LLC NPI 1972146371

NPI Information

KOINONIA COMMUNITY SERVICES LLC is an intermediate care facility mentally retarded in Broadview Heights, OH. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. KOINONIA COMMUNITY SERVICES LLC NPI is 1972146371. The provider is registered as an organization entity type.

The provider's business location address is:

2491 E WALLINGS RD
BROADVIEW HEIGHTS, OH
ZIP 44147-371
Phone: (440) 546-0153
Fax: (440) 546-0648

The provider's authorized official is Marilina Workman .
The authorized official title is Director Of Icf and has the following contact phone number (216) 588-8777.

The CLIA number assigned to this NPI record is 36D2202245 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/18/2019 and was last updated on 10/18/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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