Healthcare Provider Details

I. General information

NPI: 1376535344
Provider Name (Legal Business Name): DIGNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 PINE ST
MOUNT SHASTA CA
96067-2143
US

IV. Provider business mailing address

914 PINE ST
MOUNT SHASTA CA
96067-2143
US

V. Phone/Fax

Practice location:
  • Phone: 530-926-6111
  • Fax: 530-926-9373
Mailing address:
  • Phone: 530-926-6111
  • Fax: 530-926-9373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number230000015
License Number StateCA

VIII. Authorized Official

Name: JOE D'ANGINA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 530-225-6121