=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962527390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGNITY HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 09/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1045 ATLANTIC AVE SUITE 708
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90813-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-491-9045
-----------------------------------------------------
Fax | 562-491-9353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1045 ATLANTIC AVE SUITE 708
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90813-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-491-9045
-----------------------------------------------------
Fax | 562-491-9513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | SHARON MCNEALY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-491-9189
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number | 960001055
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------