Healthcare Provider Details

I. General information

NPI: 1215422548
Provider Name (Legal Business Name): INNOVAGE VIRGINIA PACE II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 ORIANA RD
NEWPORT NEWS VA
23608-3702
US

IV. Provider business mailing address

8950 E LOWRY BLVD
DENVER CO
80230-7030
US

V. Phone/Fax

Practice location:
  • Phone: 757-234-8100
  • Fax:
Mailing address:
  • Phone: 303-864-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateVA

VIII. Authorized Official

Name: MS. MAUREEN HEWITT
Title or Position: CEO
Credential:
Phone: 303-869-4664