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NPI Code Detail

MEDICARE: GENOA HEALTHCARE LLC

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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy
43336L0003XLong Term Care Pharmacy

General Provider Information

NPI Number : 1700327996
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 : 7224 W 400 N STE 116
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-2903
Country : US
Telephone Number : 219-210-4122
Fax Number : 219-210-4136
Authorized Official
Title or Position : SECRETARY
Name : KAREN BOHMER
Credential :
Telephone Number : 224-231-1833
Provider Enumeration Date : 03/20/2017
Last Update Date : 01/24/2024

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Directions to “GENOA HEALTHCARE LLC ” Practice Location

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