Provider Demographics
NPI:1417089350
Name:DIGNITY COMMUNITY CARE
Entity Type:Organization
Organization Name:DIGNITY COMMUNITY CARE
Other - Org Name:NORTHRIDGE HOSPITAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-885-5321
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:888-488-7667
Mailing Address - Fax:916-414-4741
Practice Address - Street 1:18300 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4105
Practice Address - Country:US
Practice Address - Phone:818-885-8500
Practice Address - Fax:818-885-5439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY COMMUNITY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000114273R00000X, 273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANHRCOtherUNIVERSAL
CA2720268OtherAETNA
CA870692258OtherIRS
CAHSC30116FMedicaid
CAZZT40116GMedicaid
CAZZZA1957ZOtherBLUE SHIELD
CA050116B0000OtherCMS SECTION 1011
CACGP00685OtherDHS
CAHSM30116GMedicaid
CAZZT30116GMedicaid
CA870692258913250000OtherWPS TRICARE
CACGP010485OtherDHS
CAHSC30116GMedicaid
CAHSM30116FMedicaid
CAZZT30116FMedicaid
CAZZT40116FMedicaid
CA050116B0000OtherCMS SECTION 1011
CA2720268OtherAETNA
CA870692258OtherIRS