Organization
INNOVAGE PENNSYLVANIA LIFE, LLC
Active
Parent organization
INNOVAGE PENNSYLVANIA LIFE - ALLEGHENY
Other names
'InnovAge Pennsylvania LIFE - LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
INNOVAGE PENNSYLVANIA LIFE - ALLEGHENY
Authorized official
GAYLE M WASHINGTON (CREDENTIALING)
(303) 912-7193
Entity
Organization
Contact information
Practice address
1940 W ALLEGHENY AVE, PHILADELPHIA, PA 19132-1614
(267) 335-1500
Mailing address
8950 E LOWRY BLVD, DENVER, CO 80230-7030
(303) 912-7193
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101734256-0001
—
PA
Enumeration date
11/09/2020
Last updated
11/09/2020
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