Provider Demographics
NPI:1619092046
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:ST. MARY MEDICAL CENTER C.A.R.E. PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER (INTERIM)
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-491-9929
Mailing Address - Street 1:1043 ELM AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3271
Mailing Address - Country:US
Mailing Address - Phone:562-624-4906
Mailing Address - Fax:562-624-4960
Practice Address - Street 1:1043 ELM AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3271
Practice Address - Country:US
Practice Address - Phone:562-624-4900
Practice Address - Fax:562-491-9128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000012261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZA0191ZOtherBLUE SHIELD
CAZZT40191HMedicaid
CA870692255OtherIRS
CAAYD000290Medicaid
0022013OtherAETNA
CAAYD000290Medicaid