Genoa Healthcare LLC
Organization Active NPI Long Term Care Pharmacy · Bend, OR
NPI 1780128520 · NPPES record last updated Jan 16, 2024
Key facts
- NPI
- 1780128520
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 1128 NW Harriman St Ste 161
Bend, OR 97703-1947 - Phone
- (541) 633-7159
- Fax
- (541) 359-2651
- NPI assigned
- Dec 13, 2016
- Organization subpart
- No
Authorized official
- Name
- Karen Bohmer
- Title
- Secretary
- Phone
- (224) 231-1833
Other NPIs on the same Medicare enrollment 16
Corporate family (same tax ID) 18
Practitioners 1
-
Adam Jose Escoto, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200924001552 | OR | Part B Supplier - Pharmacy | 6608003652 |
19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Grants Pass, OR; Salem, OR; Saint Helens, OR; Roseburg, OR; Portland, OR; Oregon City, OR; Ontario, OR; Newport, OR… |
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
1128 NW Harriman St Ste 161
Bend, OR 97703-1947
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3246
Phone (253) 218-0830
Other providers in Bend, OR
- Yvette M Gaynor
- Alexandra Gehlen
- Morgan Geiger
- Andrew Geller
- Gemini Therapeutics
- Hannah Jo George
- Samantha Georgi
- Ilona Ann Geraghty
- Maria L Gerez Serbus
- Julialauren C Gerig
All providers in Bend, OR · Long Term Care Pharmacy in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 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.