INNOVAGE PENNSYLVANIA LIFE, LLC
NPI 1467056655
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization in Philadelphia, PA

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

The NPI number for Innovage Pennsylvania Life, LLC is 1467056655. It was assigned to this organization in the NPPES registry on November 28, 2020. The provider is doing business as InnovAge Pennsylvania LIFE - St. Bart's.

Q: 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.

Active since November 28, 2020CLIA 39D2145232 · Waiver

5364 JACKSON ST, PHILADELPHIA, PA 19124(215) 288-3303 Get Directions Write a Review

NPPES record last updated: November 28, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Innovage Pennsylvania Life, Llc NPPES

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

INNOVAGE PENNSYLVANIA LIFE, LLC (NPI 1467056655), doing business as Innovage Pennsylvania Life - St. Bart's, 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 November 2020. The organization holds a CLIA Waiver certificate valid through March 4, 2028 and lists Lezlie Corbin, Credentialing Coordinator, as its authorized official.

NPPES Registry Identity

NPI1467056655

Entity TypeOrganization

Primary Taxonomy251T00000X

Legal Business NameINNOVAGE PENNSYLVANIA LIFE, LLC

Location Address5364 JACKSON STPhiladelphia, PA 19124-1565

Mailing Address8950 E Lowry BlvdDenver, CO 80230-7030 · (215) 734-9587

Phone(215) 288-3303

Organization SubpartYes

Authorized OfficialLezlie CorbinCredentialing Coordinator · (215) 734-9587

Enumeration DateNovember 28, 2020

NPPES CertifiedNovember 28, 2020

✔ NPI 1467056655 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.

5364 JACKSON ST, Philadelphia, PA 19124

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Other Names 1

Doing Business AsInnovage Pennsylvania Life - St. Bart's

Other Identifiers 1

Medicaid101734256-0004PA

CLIA Laboratory Certificates CMS CLIA

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 39D2145232

Innovage Pennsylvania Life St Bart's · Philadelphia, PA

Active · expires Mar 4, 2028

CLIA Number39D2145232

Laboratory TypePhysician Office

Certificate Effective DateMarch 5, 2026

Certificate Expiration DateMarch 4, 2028

Laboratory DirectorDr. Luz S. Ramos-Bonner

Laboratory Phone(303) 600-6930

Laboratory LocationInnovage Pennsylvania Life St Bart's5364 Jackson Street, Philadelphia, PA 19124

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

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

KARENA A GANDY CRNP

Nurse Practitioner (Family)

5364 JACKSON ST
PHILADELPHIA, PA 19124

Philadelphia County (215) 650-8204

KATHRYN ELIZABETH HURLEY OTR

Occupational Therapist

5364 JACKSON ST
PHILADELPHIA, PA 19124

Philadelphia County (860) 605-5467

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 1467056655. It was assigned to this organization in the NPPES registry on November 28, 2020. The provider is doing business as InnovAge Pennsylvania LIFE - St. Bart's.

Where is Innovage Pennsylvania Life, LLC located?

Innovage Pennsylvania Life, LLC is located at 5364 Jackson St, Philadelphia, PA 19124. The listed phone number is (215) 288-3303.

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 a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D2145232) is associated with this NPI, valid through March 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Innovage Pennsylvania Life, LLC was last updated on November 28, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.