1477610640 NPI number — DIGNITY COMMUNITY CARE

Table of content: (NPI 1477610640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477610640 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:
GLENDALE MEMORIAL HOSPITAL AND HEALTH CENTER
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:
1477610640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1420 S CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91204-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-502-1900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1420 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-502-2215
Provider Business Practice Location Address Fax Number:
818-409-7688
Provider Enumeration Date:
01/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUOYAVATIN
Authorized Official First Name:
KORA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
818-502-2204

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  930000099 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X , with the licence number: 930000099 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 930000099 , 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: 930000099 , 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: 774509 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GMH . This is a "UNIVERSAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT30058G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSM30058G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050058B000000 . This is a "CMS SECTION 1011" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CGP164950 . This is a "DHS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSC30058G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA1903Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 951642380 . This is a "IRS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 951642380912040003 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT40058G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".