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).
| 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 |
| 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 | 101734256-0004 | MEDICAID |
| Other Name | Type Code |
|---|---|
| InnovAge Pennsylvania LIFE - St. Bart's | Doing Business As Name - Organization |
| 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 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 |
|---|---|---|---|---|
| 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 |
| 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 |
5364 JACKSON ST |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19124-1565 |
| 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 | ||||
| City | PHILADELPHIA |
| Zip Code | 19124 |
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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.