Active NPI
Genoa Healthcare LLC
- Long Term Care Pharmacy
- Santa Ana, CA
National Provider Identifier
1790354702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- GENOA HEALTHCARE LLC
- Practice address
- 24422 Avenida de la Carlota, Ste 190
Room P
Santa Ana, CA 92653-3634 - Phone
- (657) 232-7819
- Fax
- (657) 276-4778
- NPI assigned
- Jun 23, 2021
- Last updated
- Sep 4, 2025
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | NU | ||
| Long Term Care Pharmacy | 3336L0003X | NU | Primary |
Addresses
Primary practice location
24422 Avenida de la Carlota, Ste 190
Room P
Santa Ana, CA 92653-3634
Mailing address
707 S Grady Way Ste 400
Renton, WA 98057-3201
Phone (253) 218-0830
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200702001353 | CA | Part B Supplier - Pharmacy | 6608003652 |
23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Visalia, CA; Santee, CA; Santa Rosa, CA; Santa Fe Springs, CA; Santa Barbara, CA; San Luis Obispo, CA; San Francisco, CA; Laguna Hills, CA… |
Other NPIs on the same Medicare enrollment 17
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624406400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1756944000000",
"number": "1790354702",
"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": "980573201",
"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": "24422 AVENIDA DE LA CARLOTA, STE 190",
"address_2": "ROOM P",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "926533634",
"telephone_number": "657-232-7819",
"fax_number": "657-276-4778"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENOA HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-06-23",
"last_updated": "2025-09-04",
"certification_date": "2025-09-04",
"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": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Ana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; 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.