Genoa Healthcare LLC
Organization Active NPI Long Term Care Pharmacy · Huntington, IN
NPI 1407598485 · NPPES record last updated Jan 19, 2024
Key facts
- NPI
- 1407598485
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 2860 Northpark Ave RM 115
Huntington, IN 46750-9700 - Phone
- (833) 905-3005
- Fax
- (260) 222-9655
- NPI assigned
- Apr 11, 2022
- Organization subpart
- No
Authorized official
- Name
- Karen Bohmer
- Title
- Secretary
- Phone
- (224) 231-1833
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200715001620 | IN | Part B Supplier - Pharmacy | 6608003652 |
This NPI is an additional NPI on the enrollment Practice locations: Kendallville, IN; Jeffersonville, IN; Jasper, IN; Knox, IN; Kokomo, IN; Lafayette, IN; Lawrenceburg, IN; Logansport, IN… |
National Provider Directory
- Tax ID family
- Genoa Healthcare LLC
Locations
2860 Northpark Ave
Rm 115
Huntington, IN 46750
Phone (833) 905-3005
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
2860 Northpark Ave RM 115
Huntington, IN 46750-9700
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830
Other providers in Huntington, IN
- Custodio A. Garrido
- Nabil A Gayed
- Vickie Jean Gayed
- Tim Gebreyes
- Stephen F Geders
- Mary Gilliam
- Alethea Gilpin
- Zachary Jacob Goetz
- Jennifer N. Goff
- Carter Gonzalez
All providers in Huntington, IN · Long Term Care Pharmacy in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 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.