GENOA HEALTHCARE, LLC (NPI# 1104171016) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104171016 |
| Entity Type | Organization |
| Organization Name | GENOA HEALTHCARE, LLC |
| Practice Address |
2925 Russell St Ste 100 Detroit MI 48207-4825 |
| Mailing Address |
Po Box 77030 Minneapolis MN 55480-7730 |
| Practice Telephone | 3138792057 |
| Practice Fax Number | 3138792058 |
| Mailing Telephone | 2532180830 |
| Mailing Fax Number | 2532174306 |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2020-03-19 |
| 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 | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
5301009854 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2167534 | 01 | |
| MI | 1104171016 | 05 |
| 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 |
2925 RUSSELL ST STE 100 |
| City | DETROIT |
| State | MI |
| Zip Code | 48207-4825 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518421072 | Charlotte Denise Miller | Pharmacist | 2925 Russell St Ste 100, Detroit, MI 48207-4825 | 2019-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245848506 | Anton R Gonzales | Physical Therapy Assistant | 2295 Chene, Detroit, Mi 48207, Detroit, MI 48207 | 2020-07-22 |
| 1033733928 | Taleshia Moss | Occupational Therapist | 2295 Chene, Detroit, MI 48207 | 2020-06-05 |
| 1942858550 | Ronald Royce Cochran | Counselor | 2925 Russell St, Detroit, Detroit, MI 48207 | 2019-08-27 |
| 1649831439 | Charday Penick | Social Worker | Team Wellness, 2925 Russell St, Detroit, MI 48207 | 2019-06-24 |
| 1568023349 | Alphia Ramona Burgess | Social Worker | Team Wellness Center, 2925 Russell Street, Detroit, MI 48207 | 2019-06-24 |
| 1447741608 | Sherice Ward | Social Worker | 100 River Place Drive, Ste 250, Detroit, MI 48207 | 2018-05-23 |
| 1427549955 | Mission Point of Detroit, LLC | Skilled Nursing Facility | 2102 Orleans, Detroit, MI 48207 | 2018-05-21 |
| 1043723737 | Olivia Carter | Case Management | 2712 Gratiot, Detroit, MI 48207 | 2017-11-16 |
| 1558885590 | Kalimah Johnson | Social Worker | 701 Mcdougall, Detroit, MI 48207 | 2017-08-01 |
| 1922534692 | Angela Young | Social Worker | 100 River Place 520, Detroit, MI 48207 | 2017-05-02 |
| Find all providers in zip 48207 | ||||
| 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 |
|---|---|---|---|---|
| 1699711101 | Henry Ford Health System | Pharmacy | 7800 W Outer Dr Ste 240, Detroit, MI 48235-3458 | 2006-06-22 |
| 1326525965 | 20201 West Seven Mile Drugs Inc | Pharmacy | 20201 W 7 Mile Rd, Detroit, MI 48219 | 2018-07-26 |
| 1811273626 | Genoa Healthcare, LLC | Pharmacy | 1700 Waterman St, Detroit, MI 48209-2022 | 2011-10-25 |
| 1760765614 | Genoa Healthcare, LLC | Pharmacy | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2011-09-27 |
| 1306151295 | Seven Mile Pharmacy LLC | Pharmacy | 14400 Gratiot Ave, Detroit, MI 48205-2307 | 2010-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437772159 | Krx Medication Consultants | Pharmacy | 8266 Fernwood St, Augusta, MI 49012 | 2020-05-28 |
| 1235751306 | Ypsilanti Family Pharmacy, Inc. | Pharmacy | 2287 Ellsworth Rd Ste A, Ypsilanti, MI 48197-4805 | 2020-05-12 |
| 1366082935 | Home Town Pharmacy Inc | Pharmacy | 1114 W South Airport Rd, Traverse City, MI 49686-4739 | 2020-01-13 |
| 1619510328 | Great Lakes Pharmacies I Inc | Pharmacy | 6213 Chicago Rd Ste 200, Warren, MI 48092-1697 | 2019-10-25 |
| 1710520143 | H & L Drugs Inc | Pharmacy | 1455 S Lapeer Rd Ste 101, Lake Orion, MI 48360-1468 | 2019-10-17 |
| 1225688229 | Guardian Pharmacy of Grand Rapids, LLC | Pharmacy | 2930 29th St Se, Grand Rapids, MI 49512-1723 | 2019-09-12 |
| 1457905259 | Senior Care Rx LLC | Pharmacy | 24293 Telegraph Rd Ste 130, Southfield, MI 48033-7924 | 2019-07-30 |
| 1063071637 | Smart Rx LLC | Pharmacy | 25464 Van Born Rd, Dearborn Heights, MI 48125 | 2019-06-07 |
| 1457812117 | Pharmtek LLC | Pharmacy | 3307 Orchard Lake Rd, Keego Harbor, MI 48320-1308 | 2019-03-26 |
| 1801350772 | Prestige Specialty Pharmacy 2 | Pharmacy | 31700 Van Dyke Ave Ste B, Warren, MI 48093-7949 | 2019-01-24 |
| 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.