Provider Demographics
NPI:1114081056
Name:DIGNITY COMMUNITY CARE
Entity Type:Organization
Organization Name:DIGNITY COMMUNITY CARE
Other - Org Name:CALIFORNIA HOSPITAL MEDICAL CENTER - LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-742-5898
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 1:1401 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3010
Practice Address - Country:US
Practice Address - Phone:213-742-5910
Practice Address - Fax:213-765-4078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY COMMUNITY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000024282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954310407900150000OtherWPS TRICARE
CAZZZA2015ZOtherBLUE SHIELD
CAZZT30149IMedicaid
CAZZT05066IMedicaid
CACGP156703OtherDHS
CA954310407OtherIRS
CAHSC30149HMedicaid
CAZZT40149IMedicaid
CA0010485OtherAETNA
CA050149B000000OtherCMS SECTION 1011
CACMCOtherUNIVERSAL
CAHSC30149IMedicaid
CACMCOtherUNIVERSAL
CAHSC30149HMedicaid