Healthcare Provider Details

I. General information

NPI: 1972637908
Provider Name (Legal Business Name): DIGNITY HEALTH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 VALLEY HI DR SUITE A
SACRAMENTO CA
95823-7076
US

IV. Provider business mailing address

3000 Q ST
SACRAMENTO CA
95816-7058
US

V. Phone/Fax

Practice location:
  • Phone: 916-681-6300
  • Fax: 916-681-6354
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA M HYLEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 916-851-2559