Provider Demographics
NPI:1477610640
Name:DIGNITY COMMUNITY CARE
Entity type:Organization
Organization Name:DIGNITY COMMUNITY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KORA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUOYAVATIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-502-2204
Mailing Address - Street 1:1420 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2508
Mailing Address - Country:US
Mailing Address - Phone:818-502-1900
Mailing Address - Fax:
Practice Address - Street 1:1420 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2508
Practice Address - Country:US
Practice Address - Phone:818-502-2215
Practice Address - Fax:818-409-7688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY COMMUNITY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000099273R00000X, 273Y00000X, 314000000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA774509OtherAETNA
CAGMHOtherUNIVERSAL
CAZZT30058GMedicaid
CAHSM30058GMedicaid
CA050058B000000OtherCMS SECTION 1011
CACGP164950OtherDHS
CAHSC30058GMedicaid
CAZZZA1903ZOtherBLUE SHIELD
CA951642380OtherIRS
CA951642380912040003OtherWPS TRICARE
CAZZT40058GMedicaid
CACGP164950OtherDHS
CAHSC30058GMedicaid
CA05T058Medicare Oscar/Certification
CA05S058Medicare Oscar/Certification