# GENOA HEALTHCARE, LLC

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

## Provider details

- **NPI number:** 1265825830
- **Authorized official:** JOSEPH DOUGLAS (CEO)
- **Authorized official phone:** (815) 404-4871

## Contact information

- **Practice address:** 940 GA HIGHWAY 96 STE 200A, WARNER ROBINS, GA 31088-2584
- **Practice address phone:** (478) 352-0916
- **Practice address fax:** (478) 987-2782
- **Mailing address:** 707 S GRADY WAY STE 700, RENTON, WA 98057-3243
- **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 | PHRE010142 | GA | Yes |

## Other

- **Enumeration date:** 03/06/2015
- **Last updated:** 09/15/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2153101 | PK | — |