Provider Demographics
NPI:1144358953
Name:DIGNITY HEALTH
Entity type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-739-3110
Mailing Address - Street 1:1530 CYPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5900
Mailing Address - Country:US
Mailing Address - Phone:805-739-3650
Mailing Address - Fax:805-922-9067
Practice Address - Street 1:1530 CYPRESS WAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5900
Practice Address - Country:US
Practice Address - Phone:805-739-3650
Practice Address - Fax:805-922-9067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000040314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55236HMedicaid
CA1245100OtherAETNA
CA651190935OtherIRS
CA651190935934540006OtherWPS TRICARE
ZZZA4203ZOtherBLUE SHIELD OF CA
CA555236Medicare Oscar/Certification