# GENOA HEALTHCARE LLC

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

## Provider details

- **NPI number:** 1760929426
- **Authorized official:** KAREN BOHMER (SECRETARY)
- **Authorized official phone:** (224) 231-1833

## Contact information

- **Practice address:** 977B TAYLOR ST SW, CONYERS, GA 30012-5357
- **Practice address phone:** (678) 209-2673
- **Practice address fax:** (770) 918-6525
- **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 | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 01/19/2017
- **Last updated:** 12/17/2024