Basic Information
| Provider Information | |||||||||
| NPI: | 1316348477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENOA HEALTHCARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3807 CLAIRMONT RD | ||||||||
| Address2: | |||||||||
| City: | CHAMBLEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303414911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129313131 | ||||||||
| FaxNumber: | 4122235384 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 PERRY HWY | ||||||||
| Address2: | BLDG 2, 3RD FLOOR | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152292220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129313131 | ||||||||
| FaxNumber: | 4122235384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2014 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | HENNESSY | ||||||||
| AuthorizedOfficialFirstName: | NATASHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF PHARMACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6127224249 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336L0003X | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
No ID Information.