Healthcare Provider Details

I. General information

NPI: 1942339015
Provider Name (Legal Business Name): GENEVA WOODS HEALTH SUPPLIES PNW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6149 MARTIN WAY E
LACEY WA
98516-5547
US

IV. Provider business mailing address

PO BOX 94347
SEATTLE WA
98124-6647
US

V. Phone/Fax

Practice location:
  • Phone: 360-456-5475
  • Fax: 360-456-5182
Mailing address:
  • Phone: 509-588-7241
  • Fax: 866-583-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number604-124-465
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number604-124-465
License Number StateWA

VIII. Authorized Official

Name: DAN AFRASIABI
Title or Position: PRESIDENT/AUTHORIZED OFFICIAL
Credential:
Phone: 888-441-1312