Provider Demographics
NPI:1083732853
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:ST. ELIZABETH COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
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 1:2550 SISTER MARY COLUMBA DR
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4327
Practice Address - Country:US
Practice Address - Phone:530-529-8000
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
CA230000036275N00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC30042GMedicaid
CAZZR00042HMedicaid
CAZZZC5202ZOtherBLUE SHIELD OF CA ACUTE
CA721561118OtherIRS FTN NUMBER
CAMTE00272FMedicaid
CA721561118960800002OtherCHAMPUS TRICARE ACUTE
CA721561118960800005OtherCHAMPUS TRICARE AMBULANCE
CAZZZ56412ZOtherBLUE SHIELD CA CARDIOLOGY
CAHSP40042HMedicaid
CAZZZC5202ZOtherBLUE SHIELD OF CA ACUTE
CA721561118OtherIRS FTN NUMBER
CA05U042Medicare Oscar/Certification