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Organization

KOINONIA FOSTER HOMES, INC.

Active
Other names
Koinonia Homes for Teens
Organization subpart
No

Provider details

NPI number
Authorized official
JARED RADDIGAN (EXECUTIVE DIRECTOR)
(916) 577-7982
Entity
Organization

Contact information

Practice address
4232 BIG CLOUD WAY, ANTELOPE, CA 95843-2406
(916) 652-0171
Mailing address
PO BOX 1403, LOOMIS, CA 95650-1403
(916) 652-2749

Taxonomy

Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
80129
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
347001884
DEPARTMENT OF SOCIAL SERVICES
CA
Enumeration date
07/15/2014
Last updated
11/03/2025
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