Healthcare Provider Details

I. General information

NPI: 1477921807
Provider Name (Legal Business Name): DIGNITY PLUS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 SOUTH MAIN STREET
CENTRAL SQUARE NY
13036
US

IV. Provider business mailing address

P.O. BOX 173
CENTRAL SQUARE NY
13036
US

V. Phone/Fax

Practice location:
  • Phone: 315-668-9381
  • Fax: 315-668-2924
Mailing address:
  • Phone: 315-668-9381
  • Fax: 315-668-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9269L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number9269L001
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number9269L001
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number9269L001
License Number StateNY

VIII. Authorized Official

Name: MR. CHAD WHITHAM PENOYER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 315-668-9381