NPIMap

Organization Active NPI

Innovage Pennsylvania Life, LLC

  • PACE Provider Organization
  • Philadelphia, PA
National Provider Identifier
1104954569
Registry record updated Apr 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
INNOVAGE PENNSYLVANIA LIFE, LLC
Practice address
6950 Germantown Ave
Philadelphia, PA 19119
Phone
(215) 951-4304
Fax
(267) 286-4910
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2019

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X Primary

Addresses

Primary practice location

6950 Germantown Ave
Philadelphia, PA 19119

Mailing address

6950 Germantown Ave
Philadelphia, PA 19119-2114
Phone (215) 951-4304

Other practice location 1

6970 Germantown Ave
Philadelphia, PA 19119-2114
Phone (215) 951-4400

Other practice location 2

6970 Germantown Ave
Philadelphia, PA 19119-2114
Phone (215) 951-4400

Other practice location 3

6950 Germantown Ave
Philadelphia, PA 19119-2114
Phone (215) 951-4304

Other identifiers 1

IdentifierTypeStateIssuer
1017342560001MedicaidPA

National Provider Directory

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

Other organizations with this tax ID 5

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

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554336000000",
    "number": "1104954569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 GERMANTOWN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191192114",
            "telephone_number": "215-951-4304",
            "fax_number": "267-286-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6950 GERMANTOWN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19119",
            "telephone_number": "215-951-4304",
            "fax_number": "267-286-4910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6970 Germantown Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191192114",
            "country_code": "US",
            "telephone_number": "215-951-4400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6970 Germantown Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191192114",
            "country_code": "US",
            "telephone_number": "215-951-4400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6950 Germantown Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191192114",
            "country_code": "US",
            "telephone_number": "215-951-4304",
            "fax_number": "267-286-4910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INNOVAGE PENNSYLVANIA LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2019-04-04",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "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": "1017342560001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 4, 2019; 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.