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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