Healthcare Provider Details

I. General information

NPI: 1104000371
Provider Name (Legal Business Name): DIGNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ALAMEDA DE LAS PULGAS
REDWOOD CITY CA
94062-2751
US

IV. Provider business mailing address

3215 PROSPECT PARK DR
RANCHO CORDOVA CA
95670-6017
US

V. Phone/Fax

Practice location:
  • Phone: 650-369-5811
  • Fax: 650-367-5100
Mailing address:
  • Phone: 916-861-1102
  • Fax: 916-861-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000045
License Number StateCA

VIII. Authorized Official

Name: GRATIA BARTON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 650-367-5837