Healthcare Provider Details

I. General information

NPI: 1255609699
Provider Name (Legal Business Name): DIGNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16337 EVERHART DR
WEED CA
96094-9400
US

IV. Provider business mailing address

3400 DATA DR 1ST FLOOR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-938-2297
  • Fax: 530-938-0494
Mailing address:
  • Phone: 530-225-6300
  • Fax: 530-225-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIM MIRANDA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 530-225-6121