Innovage Pennsylvania Life, LLC (NPI# 1023612264) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider Identifier (NPI) | 1023612264 |
| Entity Type | Organization |
| Organization Name | INNOVAGE PENNSYLVANIA LIFE, LLC |
| Practice Address |
3232 Henry Ave Philadelphia PA 19129-1241 |
| Practice Telephone | 2677742920 |
| Mailing Address |
8950 E Lowry Blvd Denver CO 80230-7030 |
| Mailing Telephone | 2157349587 |
| Authorized Official Name | Lezlie Corbin (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 2157349587 |
| Organization Subpart | Yes, this organization is a Subpart |
| Parent Organization Name | INNOVAGE PENNSYLVANIA LIFE, LLC |
| Enumeration Date | 2020-11-29 |
| Last Update Date | 2020-11-29 |
| Primary | Taxonomy | Classification | Taxonomy Group | License Number | State |
|---|---|---|---|---|---|
| Yes | 251T00000X | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | Agencies |
| State | Identifier | Issuer | Type Code |
|---|---|---|---|
| PA | 101734256-0005 | MEDICAID |
| Other Name | Type Code |
|---|---|
| InnovAge Pennsylvania LIFE- Henry Avenue | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467056655 | Innovage Pennsylvania Life, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 5364 Jackson St, Philadelphia, PA 19124-1565 | 2020-11-28 |
| 1588279657 | Innovage Pennsylvania Life, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 4401 Megargee St, Philadelphia, PA 19136-2160 | 2020-09-15 |
| 1013519735 | Innovage Pennsylvania Life, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 1940 W Allegheny Ave, Philadelphia, PA 19132-1614 | 2020-11-09 |
| 1104954569 | Innovage Pennsylvania Life, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 6950 Germantown Ave, Philadelphia, PA 19119 | 2007-02-28 |
| Taxonomy Code | 251T00000X |
| Grouping | Agencies |
| Classification | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization |
| A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights. |
| Notes: Source: Centers for Medicare and Medicaid, PACE Fact Sheet http://www.cms.hhs.gov/PACE/Downloads/PACEFactSheet.pdf [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467056655 | Innovage Pennsylvania Life, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 5364 Jackson St, Philadelphia, PA 19124-1565 | 2020-11-28 |
| 1588279657 | Innovage Pennsylvania Life, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 4401 Megargee St, Philadelphia, PA 19136-2160 | 2020-09-15 |
| 1538210380 | Trustees of The University of Pennsylvania | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 4101 Woodland Ave, Philadelphia, PA 19104-4510 | 2007-01-16 |
| 1013519735 | Innovage Pennsylvania Life, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 1940 W Allegheny Ave, Philadelphia, PA 19132-1614 | 2020-11-09 |
| 1710347661 | Trinity Health Life Pennsylvania, Inc. | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 4508 Chestnut St, Philadelphia, PA 19139-3608 | 2016-03-03 |
| 1174881627 | St. Agnes Continuing Care Center | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 1930 S Broad St, Philadelphia, PA 19145-2328 | 2012-05-02 |
| 1104954569 | Innovage Pennsylvania Life, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 6950 Germantown Ave, Philadelphia, PA 19119 | 2007-02-28 |
| 1881738565 | Saint Agnes Continuing Care Center | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 1900 S Broad St, Philadelphia, PA 19145-2304 | 2007-02-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102731 | Bitner Counseling, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 1 Northgate Sq Ste 215, Greensburg, PA 15601-1373 | 2020-07-27 |
| 1477949139 | Care At Home of Delaware Valley | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 102 Center Mill Rd, Chadds Ford, PA 19317-9212 | 2015-04-09 |
| 1659776193 | Viecare Armstrong, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 115 Nolte Drive Ext, Kittanning, PA 16201 | 2014-10-27 |
| 1851647796 | Albright Care Services | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 113 S 9th St, Lebanon, PA 17042-5108 | 2012-07-30 |
| 1023289147 | Phi Life | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 1217 Slate Hill Rd, Camp Hill, PA 17011-8012 | 2008-03-17 |
| 1740467570 | Spiritrust Lutheran Life | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 1920 Good Hope Road, Enola, PA 17025 | 2008-01-23 |
| 1710182647 | Viecare Butler, LLC | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 229 W Diamond St, Butler, PA 16001-5784 | 2007-06-20 |
| 1891822284 | Albright Life | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 417 W Frederick St, Lancaster, PA 17603-2804 | 2007-02-27 |
| 1902932007 | Albright Care Services | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 400 Lycoming St, Williamsport, PA 17701-4974 | 2007-02-26 |
| 1437205952 | Pittsburgh Care Partnership, Inc. | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | 4201 Walnut St Ste 1, Mckeesport, PA 15132-7300 | 2007-01-26 |
| Find all providers with the same taxonomy | ||||
| Street Address |
3232 HENRY AVE |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19129-1241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982243754 | Margaret Brown | Social Worker | Sherman Mills 3502 Scott's Lane, Building 16, Philadelphia, PA 19129 | 2019-12-27 |
| 1518325760 | Care365 Inc | Case Management | 3507 Scotts Ln, Ste. 1923, Philadelphia, PA 19129 | 2016-02-03 |
| 1144698408 | Raymond C Nwaneri | Nurse Practitioner | 3301 Scotts Lane, Haven Behavioral Hospital, Philadelphia, PA 19129 | 2015-09-03 |
| 1659748432 | Donna S. Wolf | Social Worker | 3302 Tilden Street, Philadelphia, PA 19129 | 2015-08-27 |
| 1891066619 | Melissa Sayer | Advanced Practice Midwife | 2450 W. Hunting Park Ave, Temple University Health System, Philadelphia, PA 19129 | 2012-01-25 |
| 1154604007 | Keystone Psychological Associates | Clinic/Center | 3502 Scotts Lane, Building 1 Suite 114, Philadelphia, PA 19129 | 2011-09-27 |
| 1174754618 | Clarence B Iszard Jr. | Counselor | 3246 North Bailey Street, Philadelphia, PA 19129 | 2009-07-31 |
| 1487816708 | St.chris Care At Northeast Pediatrics, LLC | Pediatrics | One Falls Center, 3300 Henry Avenue, 4th Floor, Philadelphia, PA 19129 | 2008-06-27 |
| 1740400845 | Sharon L. Young | Psychologist | 3205 Defense Terrace, Abbottsford Family Practice & Counseling, Philadelphia, PA 19129 | 2007-04-30 |
| 1043355621 | Donald Herman Silverman | Dentist | 3405 Warden Drive, Philadelphia, PA 19129 | 2007-02-21 |
| Find all providers in zip 19129 | ||||
| City | PHILADELPHIA |
| Zip Code | 19129 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.