Healthcare Provider Details

I. General information

NPI: 1093733776
Provider Name (Legal Business Name): PATER DIGNITAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23795 WR HOLMAN HWY
MONTEREY CA
93940-5903
US

IV. Provider business mailing address

23795 WR HOLMAN HWY
MONTEREY CA
93940-5903
US

V. Phone/Fax

Practice location:
  • Phone: 831-624-1875
  • Fax: 831-624-7138
Mailing address:
  • Phone: 831-624-1875
  • Fax: 831-624-7138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000015
License Number StateCA

VIII. Authorized Official

Name: MR. ROBERT JOSEPH BOWERSOX JR.
Title or Position: PRESIDENT ADMINISTRATOR
Credential:
Phone: 831-624-1875