Genoa Healthcare LLC
Organization Active NPI Long Term Care Pharmacy · Shelby, NC
NPI 1750006631 · NPPES record last updated Jan 26, 2024
Key facts
- NPI
- 1750006631
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 201 W Marion St Ste 100
Shelby, NC 28150-5094 - Phone
- (253) 218-0830
- Fax
- (253) 217-4306
- NPI assigned
- Oct 4, 2022
- Organization subpart
- No
Authorized official
- Name
- Karen Bohmer
- Title
- Secretary
- Phone
- (224) 231-1833
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 15
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200925002552 | NC | Part B Supplier - Pharmacy | 6608003652 |
17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Asheville, NC; Wintston Salem, NC; Wilmington, NC; Shelby, NC; Raleigh, NC; Hillsborough, NC; Hickory, NC; Greensboro, NC… |
National Provider Directory
- Tax ID family
- Genoa Healthcare LLC
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
201 W Marion St Ste 100
Shelby, NC 28150-5094
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830
Other providers in Shelby, NC
- Gaston Family Health Services, Inc.
- Gaston Family Health Services, Inc.
- Gaston Family Health Services, Inc.
- Gaston Family Health Services, Inc.
- Maria Gelabert
- Anna L. George-Trietley
- Cassia Gerolimatos
- Carla Annette Gibson-Detering
- Gift of Life of Shelby LLC
- Ariel Bumgardner Glover
All providers in Shelby, NC · Long Term Care Pharmacy in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 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.