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INNOVAGE PENNSYLVANIA LIFE, LLC
NPI 1104954569
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization in Philadelphia, PA

Active since February 28, 2007CLIA Certified · 2 labs
6950 GERMANTOWN AVE, PHILADELPHIA, PA 19119(215) 951-4304(267) 286-4910 Get Directions Write a Review

NPPES record last updated: April 4, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 4, 2019, Feb 17, 2019, Jan 18, 2019 (3 updates tracked since 2019).

About Innovage Pennsylvania Life, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

INNOVAGE PENNSYLVANIA LIFE, LLC (NPI 1104954569) is a healthcare organization registered as a program of all-inclusive care for the elderly (pace) provider organization in Philadelphia, Pennsylvania and active in the NPI registry since February 2007. The organization holds 2 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Gayle M Washington, Credentialing Director, as its authorized official.

NPPES Registry Identity

NPI1104954569
Entity TypeOrganization
Primary Taxonomy251T00000X
Legal Business NameINNOVAGE PENNSYLVANIA LIFE, LLC
Location Address6950 GERMANTOWN AVEPhiladelphia, PA 19119
Mailing Address6950 Germantown AvePhiladelphia, PA 19119-2114 · (215) 951-4304 · Fax (267) 286-4910
Phone(215) 951-4304
Fax(267) 286-4910
Organization SubpartNo
Authorized OfficialGayle M WashingtonCredentialing Director · (303) 912-7193
Enumeration DateFebruary 28, 2007
Last NPPES UpdateApril 4, 20193 updates tracked since enumeration
✔ NPI 1104954569 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyProgram of All-Inclusive Care for the Elderly (PACE) Provider OrganizationAgencies
Taxonomy Code251T00000X
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.
6950 GERMANTOWN AVE, Philadelphia, PA 19119
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Secondary Practice Locations 2

Location 16970 Germantown AvePhiladelphia, PA 19119-2114 · Phone (215) 951-4400
Location 26950 Germantown AvePhiladelphia, PA 19119-2114 · Phone (215) 951-4304 · Fax (267) 286-4910

Other Identifiers 1

Medicaid1017342560001PA

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D2171230

Innovage Pennsylvania Life- Henry Ave · Philadelphia, PA
Active · expires Aug 27, 2027
CLIA Number39D2171230
Laboratory TypePhysician Office
Certificate Effective DateAugust 28, 2025
Certificate Expiration DateAugust 27, 2027
Laboratory DirectorDr. Rachel B. Kanner Liebman
Laboratory Phone(215) 951-4400
Laboratory LocationInnovage Pennsylvania Life- Henry Ave3232 Henry Ave, Philadelphia, PA 19129
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 39D1065315

Innovage Pennsylvania Life-Allegheny · Philadelphia, PA
Active · expires Feb 26, 2027
CLIA Number39D1065315
Laboratory TypeOther
Certificate Effective DateFebruary 27, 2025
Certificate Expiration DateFebruary 26, 2027
Laboratory DirectorDr. Luz S. Ramos Bonner
Laboratory Phone(303) 300-6930
Laboratory LocationInnovage Pennsylvania Life-Allegheny1940 West Allegheny, Philadelphia, PA 19119
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VLADIMIR ZAGREBELSKY M.D.
Internal Medicine (Geriatric Medicine)
6950 GERMANTOWN AVE, NEW COURTLAND LIFE
PHILADELPHIA, PA 19119
Philadelphia County (215) 951-4400
GIA RAE BARR COTA
Occupational Therapy Assistant
6950 GERMANTOWN AVE
PHILADELPHIA, PA 19119
Philadelphia County (215) 848-3306
ANDREW GASTON
Registered Nurse
6950 GERMANTOWN AVE
PHILADELPHIA, PA 19119
Philadelphia County (215) 642-2363
MELISSA GIORDANO
Pharmacist
6950 GERMANTOWN AVE
PHILADELPHIA, PA 19119
Philadelphia County (267) 428-5187
ADRIANA EVE GALLUCCI M.A. CF-SLP
Speech-Language Pathologist
6950 GERMANTOWN AVE
PHILADELPHIA, PA 19119
Philadelphia County (215) 848-3306
GERMANTOWN HOME
Skilled Nursing Facility
6950 GERMANTOWN AVE
PHILADELPHIA, PA 19119
Philadelphia County (215) 951-4050
HELENE BAZELA PTA
Physical Therapy Assistant
6950 GERMANTOWN AVE
PHILADELPHIA, PA 19119
Philadelphia County (215) 848-3306
KEESHA L MIMMS PT, DPT
Physical Therapist
6950 GERMANTOWN AVE
PHILADELPHIA, PA 19119
Philadelphia County (215) 951-4495

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Innovage Pennsylvania Life, LLC's NPI number?

The NPI number for Innovage Pennsylvania Life, LLC is 1104954569. It was assigned to this organization in the NPPES registry on February 28, 2007.

Where is Innovage Pennsylvania Life, LLC located?

Innovage Pennsylvania Life, LLC is located at 6950 Germantown Ave, Philadelphia, PA 19119. The listed phone number is (215) 951-4304.

What is Innovage Pennsylvania Life, LLC's specialty?

The primary specialty registered for this NPI is Program of All-Inclusive Care for the Elderly (PACE) Provider Organization with taxonomy code 251T00000X.

Does Innovage Pennsylvania Life, LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Innovage Pennsylvania Life, LLC was last updated on April 4, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.