# GENOA HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205405206
- **Authorized official:** KAREN BOHMER (SECRETARY)
- **Authorized official phone:** (224) 231-1833

## Contact information

- **Practice address:** 20 W BANK ST STE 6, PETERSBURG, VA 23803-3279
- **Practice address phone:** (804) 835-5425
- **Practice address fax:** (804) 823-3345
- **Mailing address:** 707 S GRADY WAY STE 400, RENTON, WA 98057-3246
- **Mailing address phone:** (253) 218-0830
- **Mailing address fax:** (253) 217-4306

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/23/2021
- **Last updated:** 04/12/2024