Genoa Healthcare LLC
Organization Active NPI Long Term Care Pharmacy · Charlestown, MA
NPI 1063959633 · NPPES record last updated Jan 17, 2024
Key facts
- NPI
- 1063959633
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 330 Rutherford Ave Ste 1
Charlestown, MA 02129-2932 - Phone
- (617) 681-7107
- Fax
- (617) 326-5123
- NPI assigned
- Jan 20, 2017
- Organization subpart
- No
Authorized official
- Name
- Karen Bohmer
- Title
- Secretary
- Phone
- (224) 231-1833
Other NPIs on the same Medicare enrollment 20
Corporate family (same tax ID) 14
Member of 1
Practitioners 1
-
Kim Stafford, RPH
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Genoa Healthcare LLC |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Nebulizer Equipment and/or Supplies|Surgical Dressings | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200519002331 | MA | Part B Supplier - Pharmacy | 6608003652 |
22 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Framingham, MA; Worcester, MA; West Springfield, MA; Springfield, MA; Quincy, MA; Northampton, MA; Milford, MA; Marlborough, MA… |
| O20201201001973 | MA | DME Supplier - Pharmacy | 6608003652 | Practice locations: Charlestown, MA |
National Provider Directory
- Tax ID family
- Genoa Healthcare LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | |||
| Long Term Care Pharmacy | 3336L0003X | Yes |
Addresses
Primary practice location
330 Rutherford Ave Ste 1
Charlestown, MA 02129-2932
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830
Other providers in Charlestown, MA
- Michael J Garrity
- Faith Gathingu
- Marina Gretchen Gearhart
- Caitlin Geary
- Amy Violet Gennaco
- Jessica Geragosian
- Hannah Gibbon
- Dinah Gilburd
- Mia Christine Giles
- Ann Gilligan
All providers in Charlestown, MA · Long Term Care Pharmacy in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.