Provider Demographics
NPI:1235289117
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:MERCY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STRASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-564-5015
Mailing Address - Street 1:2740 M ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2813
Mailing Address - Country:US
Mailing Address - Phone:209-384-6404
Mailing Address - Fax:209-384-6699
Practice Address - Street 1:2740 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2813
Practice Address - Country:US
Practice Address - Phone:209-384-4820
Practice Address - Fax:209-384-6670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-11
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
383738197953400001OtherTRICARE WPS
ZZZ78567YOtherBSCA
383738197OtherFEDERAL TAX ID
CAHHA00117FMedicaid
CAHHA00117FMedicaid