39D2187906 CLIA NUMBER - INNOVAGE PENNSYLVANIA LIFE - PENNYPACK

Laboratory Demographics

CLIA Code: 39D2187906
Facility Name: INNOVAGE PENNSYLVANIA LIFE - PENNYPACK
Facility Address: 4401 MEGARGEE ST
PHILADELPHIA, PA
ZIP 19136
Facility Phone: 215 313-3378
Facility Type: Other - PACE ORG
Facility Type: Waiver
Lab Director: DR. LUZ S. RAMOS-BONNER
NPI Number: 1588279657
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	39D2187906
LAB Type	Other - PACE ORG
Facility Name	INNOVAGE PENNSYLVANIA LIFE - PENNYPACK
Street	4401 MEGARGEE ST
City	PHILADELPHIA
State	PA
ZIP	19136
Phone	215 313-3378
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	7/9/2024
Certificate Expiration Date	7/8/2026
Facility Type	Other - PACE ORG
Lab Director	DR. LUZ S. RAMOS-BONNER

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This page was last updated on: 6/4/2025