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Genoa Healthcare LLC

Organization Active NPI Long Term Care Pharmacy · Peru, IN

NPI 1457065534 · NPPES record last updated Apr 17, 2024

Key facts

NPI
1457065534
Entity type
Organization (NPI type 2)
Primary specialty
Long Term Care Pharmacy 3336L0003X
Legal business name
GENOA HEALTHCARE LLC
Practice address
315 W Old Key Dr Ste 130
Peru, IN 46970-9058
Phone
(765) 460-9071
Fax
(765) 588-0205
NPI assigned
Jan 12, 2023
Organization subpart
No

Authorized official

Name
Karen Bohmer
Title
Secretary
Phone
(224) 231-1833

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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 (759 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X Yes

Addresses

Primary practice location

315 W Old Key Dr Ste 130
Peru, IN 46970-9058

Mailing address

707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 17, 2024.

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1457065534",
    "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": "315 W OLD KEY DR STE 130",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469709058",
            "telephone_number": "765-460-9071",
            "fax_number": "765-588-0205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-12",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "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 Peru, IN

All providers in Peru, IN · Long Term Care Pharmacy in Indiana

Sources for this page

Verify at the official NPI Registry.