GENOA HEALTHCARE LLC NPI 1083853089

NPI Information

NPI: 1083853089
Provider Name: GENOA HEALTHCARE, LLC
Classification: Pharmacy - 3336L0003X
Entity Type: Organization

Specialization: Long Term Care Pharmacy

Address:
12800 E WARREN AVE
DETROIT, MI
ZIP 48215
Phone: (313) 347-2025
Get Directions

GENOA HEALTHCARE, LLC is a long term care pharmacy pharmacy in Detroit, MI. The provider is 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. GENOA HEALTHCARE, LLC NPI is 1083853089. The provider is registered as an organization entity type.

The provider's business location address is:

12800 E WARREN AVE
DETROIT, MI
ZIP 48215-061
Phone: (313) 347-2025
Fax: (313) 821-9015

The provider's authorized official is Joseph Douglas .
The authorized official title is Ceo and has the following contact phone number (815) 404-4871.

The enumeration date for this NPI number is 2/13/2009 and was last updated on 11/8/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332B00000X	Durable Medical Equipment & Medical Supplies				No
2	3336C0003X	Pharmacy	Community/Retail Pharmacy			No
3	3336L0003X	Pharmacy	Long Term Care Pharmacy	5301009045	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1083853089	MEDICAID	MICHIGAN
2	2167682	OTHER		PK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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