Provider Demographics
NPI:1477671535
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:MERCY MEDICAL CENTER REDDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-225-6121
Mailing Address - Street 1:PO BOX 496009
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6009
Mailing Address - Country:US
Mailing Address - Phone:530-225-6300
Mailing Address - Fax:530-225-7278
Practice Address - Street 1:2175 ROSALINE AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2509
Practice Address - Country:US
Practice Address - Phone:530-225-6300
Practice Address - Fax:530-225-7278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000024282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56236041196001B001OtherCHAMPUS TRICARE MATERNITY
CAGR0030730Medicaid
CACGP166510Medicaid
CA562360411960010000OtherCHAMPUS TRICARE ACUTE
CAZZZC4504ZOtherBLUE SHIELD OF CA ACUTE
CAZZZ56416ZOtherBLUE SHIELD CA MATERNITY
CAZZZ94524ZOtherBLUE SHIELD CA AMBULANCE
CAZZZC4504ZOtherBLUE SHIELD
CA562360411OtherIRS FTN NUMBER
CAZZR00280GMedicaid
CAZZZ56417ZOtherBLUE SHIELD CA FAMILY HTH
050280B000000OtherCMS SECTION 1011
CA562360411960010002OtherCHAMPUS TRICARE AMBULANCE
AR56236041196001A001OtherCHAMPUS TRICARE FAMILY HH
CAGR0040290Medicaid
CAHSP40280GMedicaid
CAMTE00180FMedicaid
CAZZZ56417ZOtherBLUE SHIELD CA FAMILY HTH
CAMTE00180FMedicaid