Provider Demographics
NPI:1134520828
Name:GENOA HEALTHCARE, LLC
Entity type:Organization
Organization Name:GENOA HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-722-4249
Mailing Address - Street 1:137 HOSPITAL DR NE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5063
Mailing Address - Country:US
Mailing Address - Phone:412-931-3131
Mailing Address - Fax:412-223-5384
Practice Address - Street 1:4900 PERRY HWY
Practice Address - Street 2:BLDG 2, 3RD FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229-2220
Practice Address - Country:US
Practice Address - Phone:412-931-3131
Practice Address - Fax:412-223-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy