NPIMap

Organization Active NPI

Koinonia Community Services LLC

Doing business as Van Aken House

  • Intellectual Disabilities Intermediate Care Facility
  • Cleveland, OH
National Provider Identifier
1457994840
Registry record updated Oct 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
KOINONIA COMMUNITY SERVICES LLC
Doing business as
Van Aken House
Practice address
2980 Van Aken Blvd
Cleveland, OH 44120-2862
Phone
(216) 561-7415
Fax
(216) 561-0367
NPI assigned
Oct 18, 2019
Last updated
Oct 18, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
KOINONIA COMMUNITY SERVICES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marilina Workman
Title
Director of Icf
Phone
(216) 588-8777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

2980 Van Aken Blvd
Cleveland, OH 44120-2862

Mailing address

6161 Oak Tree Blvd Ste 400
Independence, OH 44131-2581
Phone (216) 588-8777

Other names 1

  • Van Aken House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Koinonia Community Services LLC10 organizations share this tax ID, including this one
Part of
Koinonia Community Services LLC

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571356800000",
    "number": "1457994840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6161 OAK TREE BLVD STE 400",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312581",
            "telephone_number": "216-588-8777",
            "fax_number": "216-588-5670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2980 VAN AKEN BLVD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441202862",
            "telephone_number": "216-561-7415",
            "fax_number": "216-561-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOINONIA COMMUNITY SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KOINONIA COMMUNITY SERVICES LLC",
        "enumeration_date": "2019-10-18",
        "last_updated": "2019-10-18",
        "status": "A",
        "authorized_official_last_name": "WORKMAN",
        "authorized_official_first_name": "MARILINA",
        "authorized_official_title_or_position": "DIRECTOR OF ICF",
        "authorized_official_telephone_number": "216-588-8777"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Van Aken House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.