Innovage Pennsylvania Life, LLC
NPI 1104954569ActiveOrganization· PACE Provider Organization· Philadelphia, PA
PACE Provider Organization in Philadelphia, Pennsylvania, registered in NPPES in February 2007. The authorized official on file is Gayle M. Washington, Credentialing Director.
Overview
| NPI | 1104954569 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 28, 2007 |
| Last updated in NPPES | Apr 4, 2019 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| PACE Provider Organization Primary | 251T00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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