Basic Information
| Provider Information | |||||||||
| NPI: | 1881760452 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIGNITY COMMUNITY CARE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FRENCH HOSPITAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 722 E MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934544595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056145522 | ||||||||
| FaxNumber: | 8056145985 | ||||||||
| Practice Location | |||||||||
| Address1: | 1911 JOHNSON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055435353 | ||||||||
| FaxNumber: | 8055435708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2006 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8057393108 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DIGNITY COMMUNITY CARE | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 050000031 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 050232B000000 | 01 | CA | TRAILBLAZER | OTHER | 510508959 | 01 | CA | COMMERCIAL INS | OTHER | HSC30232I | 05 | CA | MEDICAID | 510508959941390000 | 01 | CA | TRIWEST | OTHER | ZZZA4000Z | 01 | CA | BLUE SHIELD | OTHER | HSP40232I | 05 | CA | MEDICAID |