Organization
TOTAL LONGTERM CARE, INC
Active
Other names
InnovAge Greater California PACE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GAYLE WASHINGTON (CREDENTIALING DIRECTOR)
(039) 127-1933
Entity
Organization
Contact information
Practice address
410 E PARKCENTER CIR N, SAN BERNARDINO, CA 92408-2869
(909) 488-4258
Mailing address
8950 E LOWRY BLVD, DENVER, CO 80230-7030
(303) 869-4664
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H6079
MEDICARE CONTRACT NUMBER
CA
Enumeration date
06/18/2013
Last updated
05/31/2022
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