NPIMap

Organization Active NPI

Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Greensboro, NC
National Provider Identifier
1770828212
Registry record updated Dec 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
3200 Northline Ave
Suite 132, Room 102
Greensboro, NC 27408
Phone
(336) 398-3997
Fax
(336) 218-6541
NPI assigned
Dec 11, 2012
Last updated
Dec 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 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 NU Primary

Addresses

Primary practice location

3200 Northline Ave
Suite 132, Room 102
Greensboro, NC 27408

Mailing address

707 S Grady Way Ste 700
Renton, WA 98057-3243
Phone (253) 218-0830

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 14

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

View all 14

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734998400000",
    "number": "1770828212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S GRADY WAY STE 700",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980573243",
            "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": "3200 NORTHLINE AVE",
            "address_2": "SUITE 132, ROOM 102",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "27408",
            "telephone_number": "336-398-3997",
            "fax_number": "336-218-6541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-11",
        "last_updated": "2024-12-24",
        "certification_date": "2024-12-24",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

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