1467560599 NPI number — DIGNITY COMMUNITY CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467560599 NPI number — DIGNITY COMMUNITY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGNITY COMMUNITY CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
METHODIST HOSPITAL OF SACRAMENTO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467560599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3215 PROSPECT PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-6017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-861-1102
Provider Business Mailing Address Fax Number:
916-861-7707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-423-3000
Provider Business Practice Location Address Fax Number:
916-423-6045
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOCIE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
916-423-6100

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  030000064 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 030000064 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HSP40590G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 721561131 . This is a "IRS - SP TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 721561131958230000 . This is a "WPS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203949200 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC00590G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CGP021560 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZR00590G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC55344G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 941580397 . This is a "PRIOR SP TAX" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZA3406Z . This is a "BLUE SHIELD OF CA" identifier . This identifiers is of the category "OTHER".




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