Healthcare Provider Details

I. General information

NPI: 1689325086
Provider Name (Legal Business Name): DIGNITY HEALTH CONNECTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY OAKS DR
REDDING CA
96003-8643
US

IV. Provider business mailing address

200 MERCY OAKS DR
REDDING CA
96003-8641
US

V. Phone/Fax

Practice location:
  • Phone: 530-226-3059
  • Fax:
Mailing address:
  • Phone: 530-223-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHANNON LOUISE KRIKORIAN
Title or Position: MANAGER
Credential:
Phone: 530-226-3059