Provider Demographics
NPI:1518085430
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:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-225-6121
Mailing Address - Street 1:P O BOX 469009
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6009
Mailing Address - Country:US
Mailing Address - Phone:530-225-6300
Mailing Address - Fax:530-225-7278
Practice Address - Street 1:914 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2143
Practice Address - Country:US
Practice Address - Phone:530-926-6111
Practice Address - Fax:530-225-7278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000015282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
050419B000000OtherCMS SECTION 1011
CA721561129OtherIRS FTN NUMBER
CAHSP40419IMedicaid
CAZZZC4704ZOtherBLUE SHIELD OF CA
CA721561129960670000OtherCHAMPUS TRICARE ACUTE
CA721561129960670001OtherCHAMPUS TRICARE SWING BED
CAHSP30419IMedicaid
CA05Z319Medicare Oscar/Certification
050419B000000OtherCMS SECTION 1011