Active NPI
Genoa Healthcare, LLC
- Long Term Care Pharmacy
- Warner Robins, GA
National Provider Identifier
1265825830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- License
- PHRE010142
- Legal business name
- GENOA HEALTHCARE, LLC
- Practice address
- 940 Ga Highway 96 Ste 200a
Warner Robins, GA 31088-2584 - Phone
- (478) 352-0916
- Fax
- (478) 987-2782
- NPI assigned
- Mar 6, 2015
- Last updated
- Sep 15, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Joseph Douglas
- Title
- Ceo
- Phone
- (815) 404-4871
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | |||
| Long Term Care Pharmacy | 3336L0003X | PHRE010142 | GA | Primary |
Addresses
Primary practice location
940 Ga Highway 96 Ste 200a
Warner Robins, GA 31088-2584
Mailing address
707 S Grady Way Ste 700
Renton, WA 98057-3243
Phone (253) 218-0830
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2153101 | Other | PK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201019001860 | GA | Part B Supplier - Pharmacy | 6608003652 |
18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Valdosta, GA; Tifton, GA; Thomasville, GA; Savannah, GA; Rome, GA; Dalton, GA; Marietta, GA; Lawrenceville, GA… |
Other NPIs on the same Medicare enrollment 18
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
940 GA Highway 96
Ste 200A
Warner Robins, GA 31088
Phone (478) 352-0916
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425600000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1663200000000",
"number": "1265825830",
"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": "940 GA HIGHWAY 96 STE 200A",
"city": "WARNER ROBINS",
"state": "GA",
"postal_code": "310882584",
"telephone_number": "478-352-0916",
"fax_number": "478-987-2782"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENOA HEALTHCARE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-03-06",
"last_updated": "2022-09-15",
"certification_date": "2022-09-15",
"status": "A",
"authorized_official_last_name": "DOUGLAS",
"authorized_official_first_name": "JOSEPH",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "815-404-4871"
},
"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": "GA",
"license": "PHRE010142",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2153101",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Warner Robins, GA
- Kirubel Gebreselassie, MD
- Gene Williams Licensed Clinical Social Worker
- Generations Homecare Solutions LLC
- Generations Marriage and Family Enrichment Center, LLC
- Genesis Gastroenterology LLC
- Georgia Behavioral Counseling, LLC
- Georgia Behavioral Services, LLC
- Georgia Cardiology Center, LLC (Georgia Cardiology Center - WR)
- Georgia CVS Pharmacy LLC (CVS Pharmacy 03773)
- Georgia CVS Pharmacy LLC (CVS Pharmacy #05631)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; 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.