# GENOA HEALTHCARE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1306362355
- **Authorized official:** KAREN BOHMER (SECRETARY)
- **Authorized official phone:** (224) 231-1833

## Contact information

- **Practice address:** 804 INDUSTRIAL PARK RD RM 27, MAXWELTON, WV 24957-8066
- **Practice address phone:** (304) 520-0576
- **Practice address fax:** (304) 497-3412
- **Mailing address:** 707 S GRADY WAY STE 400, RENTON, WA 98057-3246
- **Mailing address phone:** (253) 218-0830

## 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:** 08/21/2017
- **Last updated:** 01/24/2024