GENOA HEALTHCARE, LLC (NPI# 1093180184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093180184 |
| Entity Type | Organization |
| Organization Name | GENOA HEALTHCARE, LLC |
| Other Organization Name | GENOA HEALTHCARE, LLC |
| Practice Address |
333 E Washington St Ste 2100 West Bend WI 53095-2503 |
| Mailing Address |
Po Box 77030 Minneapolis MN 55480-7730 |
| Practice Telephone | 2623461144 |
| Practice Fax Number | 2623340209 |
| Mailing Telephone | 2532180830 |
| Mailing Fax Number | 2532174306 |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2020-03-13 |
| Authorized Official Name | WILLIAM GUPTAIL (COO) |
| Authorized Official Telephone | 2532180830 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
9358-42 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2156028 | 01 |
| Other Name | Type Code |
|---|---|
| Genoa Healthcare, LLC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972103257 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 555 Towner St Ste 1120d, Ypsilanti, MI 48198-5723 | 2020-10-27 |
| 1477153757 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 299 W Railroad Ave Ste P, Crestview, FL 32536-4053 | 2020-10-27 |
| 1033719323 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 7001 Blue Ridge Blvd Ste P, Raytown, MO 64133-5629 | 2020-10-27 |
| 1326648601 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 225 Carlton Davidson Ln Rm 1, Coal Grove, OH 45638-2924 | 2020-10-27 |
| 1912507211 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 5690 Santa Teresita Drive, Suite A2, Room P1, Santa Teresa, NM 88008 | 2020-10-27 |
| 1760080238 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 3807 N 7th St Ste P, Phoenix, AZ 85014-5005 | 2020-10-15 |
| 1174121982 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 807 Lawn Ave Ste 104, Sellersville, PA 18960-1549 | 2020-10-14 |
| 1457959272 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 281 Laclair St Rm 135, Coos Bay, OR 97420-2988 | 2020-10-14 |
| 1811595622 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 2500 W Washington Ave Ste 103, Las Vegas, NV 89106-3731 | 2020-10-14 |
| 1245844000 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 1441 E 84th Pl Rm 120, Merrillville, IN 46410-6578 | 2020-08-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Washington State Corporations | GENOA HEALTHCARE, LLC | 18300 Cascade Ave S # 251, Tukwila, WA 98188 |
| Massachusetts Corporations | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Ohio Business Entities | GENOA HEALTHCARE, LLC | 510 East Main Street, Auburn, WA 98002 |
| Vermont Business Registrations | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Connecticut Business Registrations | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Indiana Business Entities | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Street Address |
333 E WASHINGTON ST STE 2100 |
| City | WEST BEND |
| State | WI |
| Zip Code | 53095-2503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467686964 | Jodi Schrauth | Registered Nurse | 333 E Washington St Ste 2100, West Bend, WI 53095-2503 | 2009-05-12 |
| 1437715240 | Kelly Marie Bell | Social Worker | 333 E Washington St Ste 2100, West Bend, WI 53095-2503 | 2019-05-16 |
| 1922566637 | Allyssa L Bosse | Counselor | 333 E Washington St Ste 2100, West Bend, WI 53095-2503 | 2019-03-12 |
| 1740799733 | Sarah Witte | Counselor | 333 E Washington St Ste 2100, West Bend, WI 53095-2503 | 2017-09-22 |
| 1427592369 | Anthony Tadych | Counselor | 333 E Washington St Ste 2100, West Bend, WI 53095-2503 | 2016-12-12 |
| 1770940272 | Mitchell Lee Mueller | Counselor | 333 E Washington St Ste 2100, West Bend, WI 53095 | 2016-01-28 |
| 1588095178 | Kerri Corcoran | Counselor | 333 E Washington St Ste 2100, West Bend, WI 53095 | 2013-12-06 |
| 1023456175 | Jonathan France | Counselor | 333 E Washington St Ste 2100, West Bend, WI 53095-2503 | 2013-06-11 |
| 1285920736 | Ted Christopher Guszkowski | Counselor | 333 E Washington St Ste 2100, West Bend, WI 53095-2503 | 2011-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942820428 | David Fountain | Contractor | 726 Creedwood Lane, West Bend, WI 53095 | 2020-04-24 |
| 1922664358 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1745 South Main St, West Bend, WI 53095 | 2019-05-10 |
| 1912423773 | Michelle R Prentice | Family Medicine | West Bend Health Center, 1700 W. Paradise Drive, West Bend, WI 53095 | 2017-08-14 |
| 1386165918 | Quad/med, LLC | Clinic/Center | 432 E. Washington St. #1115, West Bend, WI 53095 | 2017-07-05 |
| 1508230632 | Jesen Daniel | Counselor | 111 East Washington St, Affiliated Clinical Services, West Bend, WI 53095 | 2015-12-01 |
| 1477965259 | Jenna Crofts | Specialist/Technologist | 1190 East Paradise Drive, West Bend, WI 53095 | 2014-05-28 |
| 1023436342 | Visionworks | Optometrist | 1437 S. Main St., West Bend, WI 53095 | 2014-04-03 |
| 1295157295 | Stephanie Rabe | Registered Nurse | 910 E. Paradise Drive, West Bend, WI 53095 | 2014-01-09 |
| 1477898815 | Ralph Norman Olsen | Pediatrics | 6267 Riesch Road, West Bend, WI 53095 | 2012-12-11 |
| 1932458536 | Joshua Aaron Barta | Dentist | 2090 Continental Drive, West Bend, WI 53095 | 2012-08-29 |
| Find all providers in zip 53095 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154321602 | Benevolent Corporation Cedar Community | Pharmacy | 5595 County Road Z, West Bend, WI 53095-9224 | 2005-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922646579 | Medical Health Pharmacy LLC | Pharmacy | 8845 S Greenview Dr Ste 1, Middleton, WI 53562-2562 | 2019-12-13 |
| 1124665336 | Ltc Pharmacy Services, LLC | Pharmacy | 11739 W Bradley Rd, Milwaukee, WI 53224 | 2019-12-06 |
| 1487205944 | Hayat Pharmacy 20 LLC | Pharmacy | 805 W. Layton Ave., Suite B, Milwaukee, WI 53221 | 2019-09-26 |
| 1568015022 | T A Solberg Co Inc | Pharmacy | 232 S Courtney St Stop 3, Rhinelander, WI 54501-3308 | 2019-07-23 |
| 1932679081 | Janesville Hometown Pharmacy LLC | Pharmacy | 21 S Jackson St Ste 100, Janesville, WI 53548-3859 | 2018-12-03 |
| 1902371107 | Salvanz Enterprises Inc | Pharmacy | 2673 Lineville Rd, Green Bay, WI 54313-7124 | 2018-10-04 |
| 1962999805 | Guardian Pharmacy of Madison, LLC | Pharmacy | N85 W15882 Appleton Ave, Menomonee Falls, WI 53051-3082 | 2018-04-17 |
| 1164932091 | Mabie Pharmacy, LLC | Pharmacy | 10 Liberty St # 106, Deerfield, WI 53531-9458 | 2017-10-05 |
| 1487101754 | Evergreen Pharmacy LLC | Pharmacy | 10101 W Greenfield Ave, West Allis, WI 53214-3953 | 2016-09-05 |
| 1639548142 | Lynja Inc | Pharmacy | 3215 8th St S Ste 101, Wisconsin Rapids, WI 54494-6564 | 2015-09-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.