NPIMap

Organization Active NPI

Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Hackensack, NJ
National Provider Identifier
1699008649
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
GENOA HEALTHCARE LLC
Practice address
25 E Salem St
Hackensack, NJ 07601-7427
Phone
(201) 546-5839
Fax
(201) 487-1935
NPI assigned
Sep 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NJ
Pharmacy 333600000X NJ
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X NJ Primary

Addresses

Primary practice location

25 E Salem St
Hackensack, NJ 07601-7427

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180702002830 NJ Part B Supplier - Pharmacy 6608003652 12 other NPIs on this enrollment
Practice locations: Carneys Point, NJ; Red Bank, NJ; Millville, NJ; Lakewood, NJ; Hackensack, NJ; Englewood, NJ; Cape May Court House, NJ; Camden, NJ…

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Genoa Healthcare LLC759 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

395 Main St
Hackensack, NJ 07601
Phone (201) 646-0333

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1699008649",
    "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": "25 E SALEM ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076017427",
            "telephone_number": "201-546-5839",
            "fax_number": "201-487-1935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-09",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "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": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NJ",
            "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": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.