Provider Demographics
NPI:1174917579
Name:GENEVA WOODS HEALTH SUPPLIES PNW, LLC
Entity type:Organization
Organization Name:GENEVA WOODS HEALTH SUPPLIES PNW, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AFRASIABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-441-1312
Mailing Address - Street 1:PO BOX 94347
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6647
Mailing Address - Country:US
Mailing Address - Phone:509-588-7241
Mailing Address - Fax:866-583-9296
Practice Address - Street 1:6326 E TRENT AVE STE A
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-1220
Practice Address - Country:US
Practice Address - Phone:509-867-3466
Practice Address - Fax:866-583-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604-124-465-001-0003332BP3500X, 332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2092020Medicaid
MT1174917579Medicaid
AZ082809Medicaid
PA1038339970001Medicaid
ID1174917579Medicaid
OR500736763Medicaid
IA0226655Medicaid
NM47576758Medicaid