NPIMap

Organization Active NPI

Total Longterm Care, Inc

Doing business as InnovAge Greater California PACE

  • PACE Provider Organization
  • San Bernardino, CA
National Provider Identifier
1023457595
Registry record updated May 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
TOTAL LONGTERM CARE, INC
Doing business as
InnovAge Greater California PACE
Practice address
410 E Parkcenter Cir N
San Bernardino, CA 92408-2869
Phone
(909) 488-4258
NPI assigned
Jun 18, 2013
Last updated
May 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2022

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

Authorized official

Name
Mrs. Gayle Washington
Title
Credentialing Director
Phone
(039) 127-1933

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X NU Primary

Addresses

Primary practice location

410 E Parkcenter Cir N
San Bernardino, CA 92408-2869

Mailing address

8950 E Lowry Blvd
Denver, CO 80230-7030
Phone (303) 869-4664

Other identifiers 1

IdentifierTypeStateIssuer
H6079OtherCAMEDICARE CONTRACT NUMBER

Other names 1

  • InnovAge Greater California PACE Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2067736Total Longterm Care, Inc410 E Parkcenter Circle North, San Bernardino, CA 92408Certificate of waiverOct 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Caroline Tanoe Humbles9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

350 E Parkcenter Cir N
San Bernardino, CA 92408

NPI Registry JSON

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

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653955200000",
    "number": "1023457595",
    "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": "303-869-4664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E PARKCENTER CIR N",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924082869",
            "telephone_number": "909-488-4258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL LONGTERM CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-18",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "039-127-1933",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CONTRACT NUMBER",
            "identifier": "H6079",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "InnovAge Greater California PACE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "InnovAge Greater California PACE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.