Koinonia Inn | |
4841 Auto Center Way Ste 101 Bremerton WA 98312-4388 | |
(360) 373-1529 | |
(360) 373-4051 |
Full Name | Koinonia Inn |
---|---|
Speciality | Counselor - Addiction (substance Use Disorder) |
Location | 4841 Auto Center Way Ste 101, Bremerton, Washington |
Authorized Official Name and Position | Ondrea Mccourry (EXECUTIVE ASSISTANT) |
Authorized Official Contact | 3603731529 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Koinonia Inn 4841 Auto Center Way Ste 101 Bremerton WA 98312-4388 Ph: (360) 373-1529 | Koinonia Inn 4841 Auto Center Way Ste 101 Bremerton WA 98312-4388 Ph: (360) 373-1529 |
NPI Number | 1538282272 |
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Provider Enumeration Date | 04/09/2007 |
Last Update Date | 06/25/2020 |
Certification Date | 06/25/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538282272 | NPI | - | NPPES |
1067521 | Medicaid | WA | |
1990365 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | 18027300 (Washington) | Primary |
251B00000X | Case Management | (* (Not Available)) | Secondary |
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