Provider Demographics
NPI:1447393152
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:ST. ROSE DOMINICAN HOSPITAL, ROSE DE LIMA CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-616-5507
Mailing Address - Street 1:3033 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4447
Mailing Address - Country:US
Mailing Address - Phone:602-307-2420
Mailing Address - Fax:602-798-9655
Practice Address - Street 1:102 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5575
Practice Address - Country:US
Practice Address - Phone:702-564-2622
Practice Address - Fax:702-616-5511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA659HOS-12273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1202873Medicaid
880059427890150000OtherTRICARECHAMPUS
NVNV6055OtherBLUE CROSS BLUE SHIELD
NV880059427890150008OtherTRICARECHAMPUS
NV68477OtherAETNA
NV1102873Medicaid
NV190750100OtherUS DEPT OF LABOR
NV1002873Medicaid
880059427OtherIRS
880059427890150000OtherTRICARECHAMPUS
NV190750100OtherUS DEPT OF LABOR
NV29T012Medicare Oscar/Certification