Genoa Healthcare LLC
Organization Active NPI Long Term Care Pharmacy · Maxwelton, WV
NPI 1306362355 · NPPES record last updated Jan 24, 2024
Key facts
- NPI
- 1306362355
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 804 Industrial Park Rd RM 27
Maxwelton, WV 24957-8066 - Phone
- (304) 520-0576
- Fax
- (304) 497-3412
- NPI assigned
- Aug 21, 2017
- Organization subpart
- No
Authorized official
- Name
- Karen Bohmer
- Title
- Secretary
- Phone
- (224) 231-1833
Other NPIs on the same Medicare enrollment 9
Corporate family (same tax ID) 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171130003238 | WV | Part B Supplier - Pharmacy | 6608003652 |
10 other NPIs on this enrollment Practice locations: Summersville, WV; Princeton, WV; Pleasant Valley, WV; Parkersburg, WV; Martinsburg, WV; Huntington, WV; Bridgeport, WV; Beckley, WV… |
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
804 Industrial Park Rd RM 27
Maxwelton, WV 24957-8066
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830
Other providers in Maxwelton, WV
- Sahrah Michelle Elswick
- Kimberly Estep
- Trevor M Estep
- Arielle Estes
- Jerica Rae Feury
- Niya Elise Georger
- Patrick Good
- Patricia A Gore
- Michael Anthony Griggs
- Trisha Hanna
All providers in Maxwelton, WV · Long Term Care Pharmacy in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.