| NPI | 1023612264 |
|---|---|
| Doing Business As | INNOVAGE PENNSYLVANIA LIFE- HENRY AVENUE |
| Entity Type | Organization |
| Authorized Contact | LEZLIE CORBIN Credentialing Coordinator 215-734-9587 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251T00000X PACE Provider Organization |
| Enumeration Date | 2020-11-29 |
| Last Update Date | 2020-11-29 |