Provider Demographics
NPI:1770659336
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:ARROYO GRANDE COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-739-3600
Mailing Address - Street 1:722 E MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4595
Mailing Address - Country:US
Mailing Address - Phone:805-614-5522
Mailing Address - Fax:805-614-5985
Practice Address - Street 1:345 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3896
Practice Address - Country:US
Practice Address - Phone:805-489-4261
Practice Address - Fax:805-473-7603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X
CA050000021282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40016JMedicaid
CA510509286OtherCOMMERCIAL INS
CAHSC30016JMedicaid
CA510509286941390000OtherTRIWEST
CAZZZC4001ZOtherBLUE SHIELD
CA050016B000000OtherTRAILBLAZER
CAZZZC4001ZOtherBLUE SHIELD
CAZZT40016JMedicaid
CA510509286OtherCOMMERCIAL INS