Provider Demographics
NPI:1346383338
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:ST. MARY'S MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-750-5726
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 1:450 STANYAN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1079
Practice Address - Country:US
Practice Address - Phone:415-668-1000
Practice Address - Fax:415-750-5899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000071314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
01OtherKAISER
CAZZZA3810ZOtherBLUE SHIELD
721561126OtherIRS
CALTC55833FMedicaid
CALTC55833FMedicaid