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Provider Information for 1366120784


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GENOA HEALTHCARE LLC

Organization Subpart: NO

NPI: 1366120784
Last Updated: 2024-01-22
Certification Date: 2024-01-22

Details

NameValue
NPI1366120784
Enumeration Date2023-07-06
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: KAREN BOHMER
Title: Secretary
Phone: 2242311833
Mailing Address 707 S GRADY WAY STE 400
RENTON, WA 98057-3246
United States

Phone: 253-218-0830 | Fax:253-217-4306
 
Primary Practice Address 1742 OREGON ST STE 144
REDDING, CA 96001-1717
United States

Phone: 253-218-0830 | Fax:253-217-4306
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
No 332B00000X - Durable Medical Equipment & Medical Supplies
Yes 3336L0003X - Pharmacy - Long Term Care Pharmacy