Organization
INNOVAGE PENNSYLVANIA LIFE, LLC
Active
Parent organization
INNOVAGE PENNSYLVANIA LIFE, LLC
Other names
InnovAge Pennsylvania LIFE - St. Bart's
Organization subpart
Yes
Provider details
NPI number
Legal business name
INNOVAGE PENNSYLVANIA LIFE, LLC
Authorized official
LEZLIE CORBIN (CREDENTIALING COORDINATOR)
(215) 734-9587
Entity
Organization
Contact information
Practice address
5364 JACKSON ST, PHILADELPHIA, PA 19124-1565
(215) 288-3303
Mailing address
8950 E LOWRY BLVD, DENVER, CO 80230-7030
(215) 734-9587
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101734256-0004
—
PA
Enumeration date
11/28/2020
Last updated
11/28/2020
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