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05D2067736 CLIA NUMBER - TOTAL LONGTERM CARE DBA INNOVAGE CA PACE - INLAND EMPIRE

Laboratory Demographics

CLIA Number: 05D2067736

Facility Name: TOTAL LONGTERM CARE DBA INNOVAGE CA PACE - INLAND EMPIRE

Facility Address:
410 E PARKCENTER CIRCLE NORTH
SAN BERNARDINO, CA
ZIP 92408
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Facility Phone Number: 909 890-2802

Facility Type: Other - PACE-ORGANIZATION

Certificate Type: Waiver
NPI Number: 1023457595

Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization
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.

CLIA Record

Field Name Field Value
CLIA Number 05D2067736
LAB Type Other - PACE-ORGANIZATION
Facility Name TOTAL LONGTERM CARE DBA INNOVAGE CA PACE - INLAND EMPIRE
Street 410 E PARKCENTER CIRCLE NORTH
City SAN BERNARDINO
State CA
ZIP 92408
Phone 909 890-2802
CertificateType 4
CertificateEffectiveDate 10/22/2023
CertificateExpirationDate 10/21/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024