Provider Demographics
NPI:1487694857
Name:DIGNITY HEALTH
Entity type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-453-4459
Mailing Address - Street 1:3215 PROSPECT PARK DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6017
Mailing Address - Country:US
Mailing Address - Phone:916-861-1102
Mailing Address - Fax:916-861-7707
Practice Address - Street 1:4001 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3626
Practice Address - Country:US
Practice Address - Phone:916-453-4545
Practice Address - Fax:916-453-4587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000062273Y00000X, 314000000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40017GMedicaid
CAZZR00017GMedicaid
ZZZA3401ZOtherBLUE SHIELD OF CA
942761692OtherIRS - PRE-MERGER TAX ID
CAHSC00017GMedicaid
CALTC05695GMedicaid
CALTC05695HMedicaid
CACGP000310Medicaid
CA196456502OtherDEPT. OF LABOR - WC
942761692958190000OtherWPS TRICARE
CALTC05695GMedicaid
CALTC05695HMedicaid
CAHSP40017GMedicaid