NPIMap

Organization Active NPI

Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Phoenix, AZ
National Provider Identifier
1730422601
Registry record updated Aug 24, 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
10217 N Metro Pkwy W RM A113
Phoenix, AZ 85051-1438
Phone
(602) 384-9992
Fax
(602) 944-4897
NPI assigned
Mar 29, 2013
Last updated
Aug 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

10217 N Metro Pkwy W RM A113
Phoenix, AZ 85051-1438

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200717001799 AZ Part B Supplier - Pharmacy 6608003652 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Genoa Healthcare LLC760 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Locations

10217 N Metro Pkwy W
Rm A113
Phoenix, AZ 85051
Phone (602) 384-9992

NPI Registry JSON

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724457600000",
    "number": "1730422601",
    "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": "98057",
            "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": "10217 N METRO PKWY W RM A113",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850511438",
            "telephone_number": "602-384-9992",
            "fax_number": "602-944-4897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-29",
        "last_updated": "2024-08-24",
        "certification_date": "2024-08-24",
        "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": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.