Provider Demographics
NPI: | 1609246461 |
---|---|
Name: | DIGNITY HEALTH |
Entity Type: | Organization |
Organization Name: | DIGNITY HEALTH |
Other - Org Name: | DIGNITY HEALTH SOLANO STREET MEDICAL CLINIC |
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: | 2550 SISTER MARY COLUMBA DR |
Mailing Address - Street 2: | |
Mailing Address - City: | RED BLUFF |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 96080-4327 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 530-529-8000 |
Mailing Address - Fax: | 530-529-8009 |
Practice Address - Street 1: | 2126 SOLANO ST |
Practice Address - Street 2: | |
Practice Address - City: | CORNING |
Practice Address - State: | CA |
Practice Address - Zip Code: | 96021-2713 |
Practice Address - Country: | US |
Practice Address - Phone: | 530-824-4002 |
Practice Address - Fax: | 530-824-4084 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | DIGNITY HEALTH |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2015-10-05 |
Last Update Date: | 2015-10-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |