Genoa Healthcare LLC
Organization Active NPI Long Term Care Pharmacy · Riverside, RI
NPI 1568045409 · NPPES record last updated Nov 27, 2024
Key facts
- NPI
- 1568045409
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 100 Bullocks Point Ave Ste P
Riverside, RI 02915-5351 - Phone
- (401) 236-0424
- Fax
- (401) 600-2540
- NPI assigned
- Apr 29, 2021
- Organization subpart
- No
Authorized official
- Name
- Karen Bohmer
- Title
- Secretary
- Phone
- (224) 231-1833
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201020001743 | RI | Part B Supplier - Pharmacy | 6608003652 |
7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Woonsocket, RI; Warwick, RI; Riverside, RI; Newport, RI; Providence, RI; Barrington, RI; Hope Valley, RI |
National Provider Directory
- Tax ID family
- Genoa Healthcare LLC
Locations
100 Bullocks Point Ave
Ste P
Riverside, RI 02915
Phone (401) 236-0424
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
100 Bullocks Point Ave Ste P
Riverside, RI 02915-5351
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830
Other providers in Riverside, RI
- Jessica Fresh
- Catherine Ruth Friedman
- Tanuja P Gandhi
- Katie Gangemella
- Nicole Tracy Genest
- Gerard G. Gagne, Jr. MD General Adult Psychiatry
- Maddi R Gervasio-Pontarelli
- Cassandra Ann Gibson
- Ronald Gilman
- Jessica Glover
All providers in Riverside, RI · Long Term Care Pharmacy in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 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.