OrganizationActive
Innovage Pennsylvania Life, LLC
NPI 1104954569 · PACE Provider Organization · Philadelphia, PA
Provider details
- NPI number
- 1104954569
- Entity type
- Organization
- Primary specialty
- PACE Provider OrganizationAgencies
- Authorized official
- Gayle Washington, Credentialing Director
Practice location
6950 Germantown Ave
Philadelphia, PA 19119
Phone: (215) 951-4304
Fax: (267) 286-4910
Mailing address
6950 Germantown Ave
Philadelphia, PA 19119-2114
Registry dates
- Enumerated
- 2007-02-28
- Last updated
- 2019-04-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.