=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871612614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGNITY HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 06/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 VISTA WAY
-----------------------------------------------------
City | RED BLUFF
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96080-4510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-529-7187
-----------------------------------------------------
Fax | 530-245-4060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1544 MARKET ST
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-245-4040
-----------------------------------------------------
Fax | 530-245-4060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | KIM MIRANDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-225-6121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 230000048
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------