Innovage Health Partners, Inc.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

53735 Issued in CA

Legal business name

INNOVAGE HEALTH PARTNERS, INC.

Practice address

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

Phone

(909) 890-2800

Fax

(909) 890-9615

NPI assigned

Dec 8, 2015

Last updated

Dec 8, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Vanessa D Walton

Title

Chief Legal Officer

Phone

(720) 974-2459

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1449532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449532800000",
    "number": "1992170575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 E PARKCENTER CIR N",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924082869",
            "telephone_number": "909-890-2800",
            "fax_number": "909-890-9615"
        },
        {
            "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": "909-890-2800",
            "fax_number": "909-890-9615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVAGE HEALTH PARTNERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-08",
        "last_updated": "2015-12-08",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF LEGAL OFFICER",
        "authorized_official_telephone_number": "720-974-2459"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "53735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inland Valley Drug and Alcohol Recovery Services (Inland Valley Recovery Services)
• Inland Valley Drug and Alcohol Recovery Services
• Inland Valley Recovery Services
• Inlandpsych Redlands Inc.
• Andria Denise Innerbichler, LCSW
• Inpatient Specialists of California, PC
• Insatiable Massage & Beauty SVC LLC Services
• Insite Services: Professional Clinical Counselors, Inc.
• Institute for Behavioral Health
• Institute for Behavioral Health

• Geriatric Medicine (Internal Medicine) Physician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Geriatric Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; 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.