INNOVAGE PENNSYLVANIA LIFE, LLC
NPI 1588279657
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 1588279657. It was assigned to this organization in the NPPES registry on September 15, 2020. The provider is doing business as InnovAge Pennsylvania LIFE-Pennypack.

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 September 15, 2020CLIA 39D2187906 · Waiver

4401 MEGARGEE ST, PHILADELPHIA, PA 19136(844) 292-1028 Get Directions Write a Review

NPPES record last updated: September 15, 2020. Verified against the NPPES registry weekly; last sync: September 06, 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 1588279657), doing business as Innovage Pennsylvania Life-pennypack, 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 September 2020. The organization holds a CLIA Waiver certificate valid through July 8, 2028 and lists Vanessa Deborah Walton, Chief Legal Officer, as its authorized official.

NPPES Registry Identity

NPI1588279657

Entity TypeOrganization

Primary Taxonomy251T00000X

Legal Business NameINNOVAGE PENNSYLVANIA LIFE, LLC

Location Address4401 MEGARGEE STPhiladelphia, PA 19136-2160

Mailing Address8950 E Lowry BlvdDenver, CO 80230-7030 · (844) 292-1028 · Fax (303) 869-4664

Phone(844) 292-1028

Organization SubpartYesParent: Total Community Options Inc

Authorized OfficialVanessa Deborah WaltonChief Legal Officer · (303) 242-1352

Enumeration DateSeptember 15, 2020

NPPES CertifiedSeptember 14, 2020

✔ NPI 1588279657 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.

4401 MEGARGEE ST, Philadelphia, PA 19136

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Other Names 1

Doing Business AsInnovage Pennsylvania Life-pennypack

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 39D2187906

Innovage Pennsylvania Life - Pennypack · Philadelphia, PA

Active · expires Jul 8, 2028

CLIA Number39D2187906

Laboratory TypePace Org

Certificate Effective DateJuly 9, 2026

Certificate Expiration DateJuly 8, 2028

Laboratory DirectorDr. Luz S. Ramos-Bonner

Laboratory Phone(215) 313-3378

Laboratory LocationInnovage Pennsylvania Life - Pennypack4401 Megargee St, Philadelphia, PA 19136

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

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

ROSE MERY VEGA RODRIGUEZ RN

Registered Nurse

4401 MEGARGEE ST
PHILADELPHIA, PA 19136

Philadelphia County (267) 704-9397

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 1588279657. It was assigned to this organization in the NPPES registry on September 15, 2020. The provider is doing business as InnovAge Pennsylvania LIFE-Pennypack.

Where is Innovage Pennsylvania Life, LLC located?

Innovage Pennsylvania Life, LLC is located at 4401 Megargee St, Philadelphia, PA 19136. The listed phone number is (844) 292-1028.

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 39D2187906) is associated with this NPI, valid through July 8, 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 September 15, 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.