NPIMap

Organization Active NPI

Innovage Pennsylvania Life, LLC

  • PACE Provider Organization
  • Philadelphia, PA
National Provider Identifier
1013519735
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
INNOVAGE PENNSYLVANIA LIFE, LLC
Practice address
1940 W Allegheny Ave
Philadelphia, PA 19132-1614
Phone
(267) 335-1500
NPI assigned
Nov 9, 2020
Organization subpart
Yes
Parent organization
INNOVAGE PENNSYLVANIA LIFE - ALLEGHENYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gayle M Washington
Title
Credentialing
Phone
(303) 912-7193

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X Primary

Addresses

Primary practice location

1940 W Allegheny Ave
Philadelphia, PA 19132-1614

Mailing address

8950 E Lowry Blvd
Denver, CO 80230-7030
Phone (303) 912-7193

Other identifiers 1

IdentifierTypeStateIssuer
101734256-0001MedicaidPA

Other names 1

  • 'InnovAge Pennsylvania LIFE - LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Innovage Pennsylvania Life LLC6 organizations share this tax ID, including this one
Part of
Innovage Pennsylvania Life LLC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604880000000",
    "number": "1013519735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8950 E LOWRY BLVD",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802307030",
            "telephone_number": "303-912-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 W ALLEGHENY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191321614",
            "telephone_number": "267-335-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVAGE PENNSYLVANIA LIFE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INNOVAGE PENNSYLVANIA LIFE - ALLEGHENY",
        "enumeration_date": "2020-11-09",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "303-912-7193"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101734256-0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "'InnovAge Pennsylvania LIFE - LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.