Provider Demographics
NPI:1528199502
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:NORTHRIDGE HOSPITAL MEDICAL CENTER - SHERMAN WAY CAMPUS
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:TAYLOR
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:916-861-1102
Mailing Address - Fax:916-861-7707
Practice Address - Street 1:14500 SHERMAN CIR
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3052
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 HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000169273R00000X, 282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40299JMedicaid
CAHSC30299JMedicaid
CA870692259914050000OtherWPS TRICARE
CALTC70143FMedicaid
CANOHSOtherUNIVERSAL
CAHSM30299JMedicaid
CAZZT30299JMedicaid
CAZZZA1962ZOtherBLUE SHIELD
CA0777367OtherAETNA
CA870692259OtherIRS
CAZZZA1962ZOtherBLUE SHIELD
CA870692259914050000OtherWPS TRICARE
CA05S299Medicare Oscar/Certification