Genoa Healthcare LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

GENOA HEALTHCARE LLC

Practice address

436 E Washington Blvd Ste P
Fort Wayne, IN 46802-3210

Phone

(206) 222-2952

Fax

(260) 420-5829

NPI assigned

Jan 15, 2020

Organization subpart

No

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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Pittsburgh, PA
  • NPI 1356331516

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1023658283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S GRADY WAY STE 700",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980573243",
            "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": "436 E WASHINGTON BLVD STE P",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468023210",
            "telephone_number": "206-222-2952",
            "fax_number": "260-420-5829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-15",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Generational Medical LLC
• Generational Services LLC
• Generations Family Eyecare, PC
• Basil C Genetos, MD
• Lili Geng, MD
• Genoa Healthcare LLC
• Genoa Healthcare LLC
• Genoa Healthcare LLC
• Genoa Healthcare LLC
• Rachael Gent

• Long Term Care Pharmacy in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Long Term Care Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; 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.