NPIMap

Organization Active NPI

Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Tempe, AZ
National Provider Identifier
1013276047
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
GENOA HEALTHCARE LLC
Practice address
1642 S Priest Dr
BLDG 6 Ste 101
Tempe, AZ 85281-6204
Phone
(480) 296-0097
Fax
(480) 921-4127
NPI assigned
May 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Karen Bohmer
Title
Secretary
Phone
(224) 231-1833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

1642 S Priest Dr
BLDG 6 Ste 101
Tempe, AZ 85281-6204

Mailing address

707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200717001799 AZ Part B Supplier - Pharmacy 6608003652 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Genoa Healthcare LLC759 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1013276047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S GRADY WAY STE 400",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980573246",
            "telephone_number": "253-218-0830",
            "fax_number": "253-217-4306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1642 S PRIEST DR",
            "address_2": "BLDG 6 STE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852816204",
            "telephone_number": "480-296-0097",
            "fax_number": "480-921-4127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-11",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "BOHMER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "224-231-1833"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.