| NPI | 1013519735 |
|---|---|
| Doing Business As | "INNOVAGE PENNSYLVANIA LIFE - LLC |
| Entity Type | Organization |
| Authorized Contact | GAYLE M WASHINGTON Credentialing 303-912-7193 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251T00000X PACE Provider Organization |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2020-11-09 |