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
Certification Date: 2024-01-22
Details
Name | Value | ||||||||||||||||||||
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NPI | 1366120784 | ||||||||||||||||||||
Enumeration Date | 2023-07-06 | ||||||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||||||
Status | Active | ||||||||||||||||||||
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 | ||||||||||||||||||||
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