Provider Demographics
NPI:1740304112
Name:DIGNITY HEALTH
Entity type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-462-7504
Mailing Address - Street 1:1555 SOQUEL DR
Mailing Address - Street 2:HOME HEALTH
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1705
Mailing Address - Country:US
Mailing Address - Phone:831-462-7501
Mailing Address - Fax:831-462-7555
Practice Address - Street 1:2045 40TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2549
Practice Address - Country:US
Practice Address - Phone:831-465-7988
Practice Address - Fax:831-465-7996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000473251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24141ZOtherBLUE SHIELD
CACGP170499OtherDHS
721561119OtherIRS - SP TAX ID
CAHHA08052GMedicaid
CA058052Medicare Oscar/Certification