Basic Information
| Provider Information | |||||||||
| NPI: | 1760510937 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIGNITY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 722 E MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934544595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056145539 | ||||||||
| FaxNumber: | 8057393951 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 E CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934545906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393000 | ||||||||
| FaxNumber: | 8057393951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 12/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSEN | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8057393110 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DIGNITY HEALTH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | N | Hospital Units | Rehabilitation Unit | 282N00000X | 050000040 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1045100 | 01 | CA | AETNA | OTHER | ZZT40107H | 05 | CA | MEDICAID | ZZZA4203Z | 01 | CA | BLUE SHIELD | OTHER | 651190935934540000 | 01 | CA | WPS TRICARE | OTHER | ZZT30107H | 05 | CA | MEDICAID | 651190935 | 01 | CA | IRS | OTHER |