=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225184963
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGNITY HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 03/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 S COLLEGE DR
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-5325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-739-3830
-----------------------------------------------------
Fax | 805-739-3838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 S COLLEGE DR
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-5325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-739-3830
-----------------------------------------------------
Fax | 805-739-3838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | SUE ANDERSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-739-3110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 050000233
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------