Active NPI
Genoa Healthcare LLC
- Long Term Care Pharmacy
- Winter Haven, FL
National Provider Identifier
1376645127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 1201 1St St S Ste B1185
Winter Haven, FL 33880-3904 - Phone
- (863) 291-4707
- Fax
- (863) 291-4823
- NPI assigned
- Sep 2, 2006
- 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
- Karen Bohmer
- Title
- Secretary
- Phone
- (224) 231-1833
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 | Primary |
Addresses
Primary practice location
1201 1St St S Ste B1185
Winter Haven, FL 33880-3904
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
1201 1st St S
Ste B1185
Winter Haven, FL 33880
Phone (863) 291-4707
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1734998400000",
"number": "1376645127",
"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": "1201 1ST ST S STE B1185",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338803904",
"telephone_number": "863-291-4707",
"fax_number": "863-291-4823"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENOA HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-02",
"last_updated": "2024-12-24",
"certification_date": "2024-12-24",
"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": []
}
Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.