Healthcare Provider Details

I. General information

NPI: 1255609772
Provider Name (Legal Business Name): CARE WITH DIGNITY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9474 CHESAPEAKE DR SUITE 907
SAN DIEGO CA
92123-1047
US

IV. Provider business mailing address

9474 CHESAPEAKE DR SUITE 907
SAN DIEGO CA
92123-1047
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-4390
  • Fax: 858-571-4393
Mailing address:
  • Phone: 858-571-4390
  • Fax: 858-571-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number080000282
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL JOHN BAKER
Title or Position: CONTROLLER
Credential: CPA
Phone: 858-571-4390