Provider Demographics
NPI:1265876700
Name:DIGNITY HEALTHCARE II LLC
Entity type:Organization
Organization Name:DIGNITY HEALTHCARE II LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BRUMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-723-2095
Mailing Address - Street 1:800 W HAYNIE ST
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-1905
Mailing Address - Country:US
Mailing Address - Phone:325-247-4194
Mailing Address - Fax:
Practice Address - Street 1:800 W HAYNIE ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-1905
Practice Address - Country:US
Practice Address - Phone:817-723-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-27
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001021216Medicaid
TX675076Medicare Oscar/Certification