Organization
GENOA HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN BOHMER (SECRETARY)
(224) 231-1833
Entity
Organization
Contact information
Practice address
415 N 26TH ST, LAFAYETTE, IN 47904-2895
(765) 588-3359
(765) 807-8020
Mailing address
707 S GRADY WAY STE 400, RENTON, WA 98057-3246
(253) 218-0830
(253) 217-4306
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
IN
333600000X
Pharmacy
—
IN
3336L0003X
Long Term Care Pharmacy
Primary
—
IN
Other
Enumeration date
07/02/2010
Last updated
01/22/2024
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