Healthcare Provider Details

I. General information

NPI: 1548629306
Provider Name (Legal Business Name): DIGNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W THOMAS RD
PHOENIX AZ
85013-4407
US

IV. Provider business mailing address

371 BONNIE LN
SYLVA NC
28779-5610
US

V. Phone/Fax

Practice location:
  • Phone: 828-507-8959
  • Fax:
Mailing address:
  • Phone: 828-477-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberSP23442
License Number StateCA

VIII. Authorized Official

Name: MEREDITH AUBREY FONSECA
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 828-477-4200