MEDICARE: DIGNITY HEALTH MEDICAL FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34AF	OTHER	CA	COUNTY

General Provider Information

NPI Number	:	1972637908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGNITY HEALTH MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	3000 Q ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7058
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6615 VALLEY HI DR
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-7076
Country	:	US
Telephone Number	:	916-681-6300
Fax Number	:	916-681-6354

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	THERESA M HYLEN
Credential	:
Telephone Number	:	916-851-2559

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	11/18/2020

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Directions to “DIGNITY HEALTH MEDICAL FOUNDATION ” Practice Location

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