1114081056 NPI number — DIGNITY COMMUNITY CARE

Table of content: (NPI 1114081056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114081056 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:
CALIFORNIA HOSPITAL MEDICAL CENTER - LOS ANGELES
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:
1114081056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2021
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:
1401 S GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90015-3010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-742-5910
Provider Business Practice Location Address Fax Number:
213-765-4078
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHENG
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
213-742-5898

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  930000024 , 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: 930000024 , 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: 954310407900150000 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZA2015Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT30149I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT05066I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CGP156703 . This is a "DHS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 954310407 . This is a "IRS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSC30149H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40149I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0010485 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 050149B000000 . This is a "CMS SECTION 1011" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CMC . This is a "UNIVERSAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSC30149I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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