Provider Demographics
NPI:1174107304
Name:KOINONOS HEALTH CARE LLC
Entity type:Organization
Organization Name:KOINONOS HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADASU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-951-5482
Mailing Address - Street 1:17431 CROSSCOVE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4495
Mailing Address - Country:US
Mailing Address - Phone:832-951-5482
Mailing Address - Fax:
Practice Address - Street 1:17431 CROSSCOVE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-4495
Practice Address - Country:US
Practice Address - Phone:832-951-5482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR58638245OtherBLUECROSS BLUESHIELD