NPIMap

Organization Active NPI

Koinonia Community Services LLC

  • Intellectual Disabilities Intermediate Care Facility
  • Broadview Heights, OH
National Provider Identifier
1972146371
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
Practice address
2491 E Wallings Rd
Broadview Heights, OH 44147-1371
Phone
(440) 546-0153
Fax
(440) 546-0648
NPI assigned
Oct 18, 2019
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

2491 E Wallings Rd
Broadview Heights, OH 44147-1371

Mailing address

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

Other names 1

  • Wallings 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": "1972146371",
    "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": "2491 E WALLINGS RD",
            "city": "BROADVIEW HEIGHTS",
            "state": "OH",
            "postal_code": "441471371",
            "telephone_number": "440-546-0153",
            "fax_number": "440-546-0648"
        }
    ],
    "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": "Wallings House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broadview Heights, 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.