Provider Demographics
NPI:1659437135
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:HOSPICE OF NORTHERN NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAKYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-770-6239
Mailing Address - Street 1:18653 WEDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3005
Mailing Address - Country:US
Mailing Address - Phone:775-770-3081
Mailing Address - Fax:775-770-3909
Practice Address - Street 1:18653 WEDGE PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3005
Practice Address - Country:US
Practice Address - Phone:775-770-3081
Practice Address - Fax:775-770-3909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV676HPC-17251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
880059665OtherIRS - SP TAX ID
NV006416009Medicaid
NV006516009Medicaid
291501Medicare Oscar/Certification