MEDICARE: GENOA HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1154630598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENOA HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	707 S GRADY WAY STE 400
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-3246
Country	:	US
Telephone Number	:	253-218-0830
Fax Number	:	253-217-4306

Provider Business Practice Location Address
First Line	:	5710 N BROADWAY ST STE P
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-4302
Country	:	US
Telephone Number	:	773-728-2310
Fax Number	:	773-728-2352

Authorized Official
Title or Position	:	SECRETARY
Name	:	KAREN BOHMER
Credential	:
Telephone Number	:	224-231-1833

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	12/26/2024

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Directions to “GENOA HEALTHCARE LLC ” Practice Location

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