Basic Information
| Provider Information | |||||||||
| NPI: | 1295928349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENOA HEALTHCARE OF KENTUCKY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980025502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532180830 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 MECHANIC ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405071004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593896404 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 03/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | JASON | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACTS ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2532180862 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | P07131 | KY | N | Suppliers | Durable Medical Equipment & Medical Supplies | 3336L0003X | P07131 | KY | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
No ID Information.