Innovage Pennsylvania Life, LLC
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

Address: 5364 Jackson St, Philadelphia, PA 19124-1565
Phone: 2152883303

Innovage Pennsylvania Life, LLC (NPI# 1467056655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1467056655
Entity Type Organization
Organization Name INNOVAGE PENNSYLVANIA LIFE, LLC
Practice Address 5364 Jackson St
Philadelphia
PA 19124-1565
Practice Telephone 2152883303
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 2020-11-28
Last Update Date 2020-11-28

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 251T00000X Program of All-Inclusive Care for the Elderly (PACE) Provider Organization Agencies

Other Provider Identifier

State Identifier Issuer Type Code
PA 101734256-0004 MEDICAID

Other Provider/Organization Names

Other Name Type Code
InnovAge Pennsylvania LIFE - St. Bart's Doing Business As Name - Organization

Providers with the same name

NPI Name Taxonomy Address Enumeration
1023612264 Innovage Pennsylvania Life, LLC Program of All-Inclusive Care for the Elderly (PACE) Provider Organization 3232 Henry Ave, Philadelphia, PA 19129-1241 2020-11-29
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 Information

Taxonomy Code 251T00000X
Grouping Agencies
Classification Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

Taxonomy Definition

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]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1023612264 Innovage Pennsylvania Life, LLC Program of All-Inclusive Care for the Elderly (PACE) Provider Organization 3232 Henry Ave, Philadelphia, PA 19129-1241 2020-11-29
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

Providers in the same taxonomy and state

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

Office Location

Street Address 5364 JACKSON ST
City PHILADELPHIA
State PA
Zip Code 19124-1565

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1831749308 William Mark Hanna Sr. Pharmacist 4600 Rooselvelt Blvd Bldg G, Philadelphia, PA 19124 2019-09-17
1881256451 Medical Discovery Systems, LLC Durable Medical Equipment & Medical Supplies 5425 Oxford Ave., 5425 Oxford Ave. Suite (3 A), Philadelphia, PA 19124 2019-07-03
1548731391 Sierra Pinkney Registered Nurse 1615 Granite St, Philadelphia, PA 19124 2018-12-05
1922507987 Xavier Sergio Henriquez Counselor 4510 Frankford Avenue 2nd Floor, Philadelphia, PA 19124 2018-02-06
1558881581 Isabel Cristina Castillo Hernandez Pediatrics 4500-10, Apt 201b, Philadelphia, PA 19124 2017-06-21
1952843732 Patrick Grugan Social Worker Roosevelt Boulevard & Adams Avenue, Philadelphia, PA 19124 2016-11-10
1811340482 Katarzyna Liwski Psychiatry & Neurology 4641 Roosevelt Boulevard, E212, Drexel University College of Medicine Friends Hospital, Philadelphia, PA 19124 2016-07-19
1851769327 Aleka Kostouros Social Worker Roosevelt Blvd & Adams Ave, Northeast Community Center for Behavioral Health, Philadelphia, PA 19124 2015-09-14
1407230378 Sara Bachani Psychiatry & Neurology 4641 Roosevelt Blvd, Friends Hospital, Room 231, Philadelphia, PA 19124 2015-07-10
1215327051 Alyssa Renee Kirk Counselor 4500-10 Frankford Ave, 2nd Floor, Philadelphia, PA 19124 2015-02-02
Find all providers in zip 19124

Competitor

Search similar providers

City PHILADELPHIA
Zip Code 19124

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Dataset Information

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.